What is Cervical Shortening (or Cervical Insufficiency)?

The cervix is the narrow, tubular, lower end of the uterus that extends into the vagina. When you’re not pregnant, the cervical canal remains open a tiny bit to allow sperm to enter the uterus and menstrual blood to flow out. Once you become pregnant, secretions fill the canal and form a protective barrier called the mucous plug. During a normal pregnancy, the cervix remains firm, long, and closed until late in the third trimester. At that point it usually starts to soften, shorten (efface) and open up (dilate) as your body prepares itself for labor.

Cervix is located in the lower part of the Uterus. (source: A.D.A.M and Medline)

Normally, in the late second and early third trimester the cervical length measures anywhere between 3 cm to 3.5 cm (30-35mm) and decreases progressively as the pregnancy advances, in preparation for labor (source: Obstetrics and Gynecology Board Review Manual).

In cervical insufficiency, the cervix becomes softer and weaker than normal or is abnormally short to begin with. It may efface and dilate without contractions in the second or early third trimester as the weight of the growing baby puts increasing pressure on it. This condition can sometimes result in second term miscarriage, or premature rupture of the bag of waters, which can then result in preterm labor, especially before the 34th week.

Several studies have indicated that the likelihood of preterm delivery increases with decreasing cervical length. A cervical length of 25–30 mm before 32 weeks gestation seems to increase the risk of preterm delivery. If examination and ultrasound show that you have an abnormally short cervix, and you’re less than 24 weeks pregnant, your practitioner may recommend “cerclage”, a procedure in which she stitches a band of strong thread around your cervix to reinforce it and help hold it closed. However, there’s a lot of controversy about whether cerclage should be used in this situation.

Some recent research questions the effectiveness of the procedure at preventing miscarriage or preterm birth except in a small number of circumstances. And the procedure itself can lead to preterm delivery caused by uterine infection, ruptured membranes, and uterine “irritation” leading to contractions.

In certain other conditions, the benefits of cerclage can outweigh the risks. Women who seem to benefit from cerclage include those who’ve had three or more unexplained second-trimester losses or preterm births. If you’re in this group, you’re likely to get a cerclage at 13 to 16 weeks, before your cervix starts to change. A cerclage done then appears less risky than one done later in pregnancy, after your cervix has started to change. Once this procedure is done, you will be continually monitored by your obstetrician, until about 37 weeks, when the stitches can come out, and you can wait for labor to begin.

If this condition is discovered in the third trimester, bed rest or modified bed rest, would be the preferred choice, as opposed to cerclage. Although there’s no solid evidence that staying in bed is effective, the theory is that keeping the weight of the uterus off of a weakened cervix might help.

After going through a lot of recent research and literature, I have put together some recommendations for expectant mothers who are diagnosed with cervical shortening.

Women with cervical measurements exceeding 26 mm should be just observed, and reassessed in 2-3 weeks.

Women with cervical lengths between 21-25 mm should be placed on reduced physical activity, with re-measurement in 2 weeks.

Women with cervical lengths between 16-20 mm should be placed on strict bed rest, with re-measurement in 1 week.

Only women with cervical lengths of 15 mm or less should be considered for therapeutic cerclage.

At this time, no evidence supports measuring cervical length or placing cerclage in the low-risk patient. This means, no scans and no other physical checks or interventions are recommended in the absence of symptoms and/or high risk in the expectant mother.

While this is probably a good point of reference to start, it obviously needs to be taken within the context of the rest of your physical examination findings, and your obstetrician’s recommendations. In addition, your obstetrician will decide what the best intervention is for you, depending upon when your cervical shortening is diagnosed. For more details on this particular topic you can look at information available in the following websites:

Cervix length of 3.2 cms at this stage of your pregnancy, in itself does not indicate major risk. Your obstetrician will continue to monitor you over a period of time. Aproximately every 3 weeks or so, your cervical length can be measured through scans. If it continues to shorten, she may recommend placement of sutures around your cervix (cerclage) and reduced physical activity or bed rest depending on the amount of shortening. However, if your cervix continues to maintain its length, nothing further needs to be done, and you can enjoy the rest of your pregnancy. Hope this helps.. good luck!

I am 23 wks preg. and my cervix is 2.8cm, I have have 3 previous D&Es before I was 24. I am now 27. The baby also has his head resting right againts my cervix according to mu u/s yesterday. What do you think will happen?

My daughter, 35-2/3 is expecting twins. She had 3 leep procedures and had a cerclage @ 14 wks. She is on modified bedrest and is in her 32nd week. Cervix shortening from 4 to 3 last week. They are removing the cerclage 9-11. Does the shortening of the cervix in that weeks time period signal impending birth?

Your cervical length is in a region where it would require very close monitoring, coupled with reduced physical activity and/or bed-rest. It would also depend on whether your previous D&Es were elective procedures, or whether it was a medical requirement.

Since you have quite a few weeks to go before delivery, your obstetrician will most likely recommend cerclage.

Since your daughter is carrying twins, there are chances that she will deliver sometime soon after her cerclage is removed. However, since her cervix has shortened even with the cerclage in place over one week, she will need to be constantly monitored. Complete bed-rest would most likely increase the chances of carrying the babies longer towards her due date/date of removal of cerclage.

At 36 weeks , the babies lungs are mature, and they would be ready for delivery. If with monitoring over the next weeks, your daughter’s cervical length further decreases, her obstetrician will most likely give her injections to help the babies lungs mature.

Thank you for your quick response. Her husband is in Iraq so I plan to fly up next week.

She is going twice a week, once for non stress tests and then for ultrasound. She said the babies were “practice breathing” in the ultrasound yesterday. She also is having contractions at the rate of about four per hour.

3 cm cervical length is on the borderline of normal range. Most research indicates that no special precautions need be taken at this particular point of time. However, considering that you are in the 29th week, I am sure that your obstetrician will want to monitor you with repeat ultrasounds every 3 weeks or so. In case, further shortening does occur, you may be advised reduced physical activity and/or modified bed-rest to increase your chances of carrying your baby to term.

One of the moms in my program was diagnosed with cervical shortening (less than 2 cm) in her 34th week of pregnancy. With modified bed-rest and reduced physical activity, she has now carried her baby to term, and is now eagerly awaiting for her labor to start :)

Dear Dr. Vijaya,
My sister-in-law is 10-11th week pregnant and today she got a cervical cerclage. As you have suggested to Luveena that having 3.0cm cervical length is on the borderline of normal range. I am confused that though my sis-in-law has 3.2cm cervical length, why cerclage was the option. She is asked to have bed rest for a week. Previously, she had two miscarriages first at 2 months and 2nd was at five months. Could this be the reason to undergo for a cerclage despite having normal cervix length? or is it because of having 3.2cm cervical length at 10-11week pregnancy?
She is travelling on 9th september from india to france (pretty long flight). Is it risky to travel on air for long hours? I am terrified because I am myself due on first week of october and she will be here for three months. she will bring her medicines enough for three months but is it enough visiting a doctor once a month in such case?

Most likely reason for your sister-in-law to have had cerclage would be because of her two previous miscarriages. Although the first one was pretty early in pregnancy, the second one was a second trimester loss of pregnancy. This is usually a pretty good reason to perform preventative cerclage, especially with her borderline cervical length.

In terms of whether it is safe to have a long air travel, this would depend upon how well she does with her bed-rest over the next week. If there are no adverse effects from the cerclage placement, her obstetrician will probably give her the green signal to go ahead. Since she is only at 10-11 weeks, air travel should not have any other impact at this stage.

Once she is in France, yes – once a month appointments should be good enough. I do suggest that her first two appointments be done at 15 day intervals since her cerclage procedure has just been done. Once it is established that her cervical condition is stable, then usual once a month check-ups will do just fine. Hope this answers all your questions.

Good luck with your own pregnancy .. Enjoy the last few weeks before you have newborn :) I am sure all will go well for both you and your sister-in-law.

Of all the articles that I have read, yours has BY FAR been the absolute most helpful! I now understand why they do not want to place a cerclage yet.

I am 20.5 weeks pregnant, and last week, I had a small Y funnel with cervical length of 3cm, and it did not open further with pressure. Now this week, my u/s showed cervical length of 2.6 cm (although, doctor remeasured the u/s photo and changed it to 2.8), with the funnel being a deeper V, opening further with pressure.

Is that a huge change in just one week? And they are not prepared at this time to place a cerclage, stating it could actually rupture the membranes.

Could you please give my chances straight to me? Like 25% I’ll deliver before 24 weeks, or 10% chance to make it to 36 weeks, etc. etc.?

I have been placed on bedrest and will have the cervix checked via u/s every week.

Dr. Vijaya-
Your emails to the others have been useful, but I’m not reading anything that’s similar to mine. So I hope you have some information/advice for my situation. I’m 25w3d with twins and just got back from the doctor where he did a vaginal sonogram to measure my cervix. At first it measured 3.5cm but then it was as if my cervix relaxed and he said it was funneling (outside to in) and remeasured at 1.98cm. He said that if it gets to 1.5cm he’ll put me in the hospital.
I’m already on a modified bed rest because of contractions and dark discharge, but on a stricter bed rest now. I also have a check-up with my perinatal nurse on Thursday where my doctor has asked that I be remeasured.
What are my chances of hanging on for several more weeks?
What are my boys chances of survival this early?
Thank you.
Miranda

Thank you for your kind words .. I was out attending a Lamaze conference and hence could not reply immediately.

A further shortening of the cervix, coupled with greater funneling with trans-abdominal pressure definitely needs to be monitored rigorously. Strict bed rest is the only dictum to follow at this stage.

I wish I could tell you what percentage chances you have of hanging in there – there is only one study that I came across trying to predict premature birth and this was done in moms carrying twins. For them, they found that the chances of having premature labor was 17% in women with cervical length of 2 cm, and 12% in women with cervical length of 2.5 mm.

In terms of your chances of hanging in their for several more weeks, I would definitely wait and watch what effect your stricter bed rest has on your cervical condition over the course of the next couple of weeks.

In my response to Stacie, I mentioned about a study that I came across which specifically looked at the risk of premature delivery in twin pregnancies. Skenton (2001) studied 464 twin pregnancies between 22-24 weeks. With average length of cervix measuring at 36 mm (3.6cm), the findings with respect to women with cervical shortening were as follows:

This is only one study, and I do not know how applicable it may be to general populations.

Has your provider recommended a fibronectin test? In expectant mothers where cervical funneling and shortening are accompanied by preterm contractions, a fetal fibronectin test can sometimes provide a clue. In this test, a swab of the vagina is obtained from near the cervix. Fetal fibronectin is a glycoprotein that acts like a “glue” between bag of membranes and cervix. Normally, this is not released until late in pregnancy/near delivery. In women who tend to deliver early, this can become positive much early in pregnancy.

Having said that, studies have also found that though this test is highly accurate when negative, it may not be as accurate when positive. What this means is that, even if you test positive for fetal fibronectin, it does not mean that you will absolutely deliver prematurely. What studies have found is that, a positive fetal fibronectin, coupled along with further shortening of the cervix, may be predictive of preterm labor.

Some providers will start giving steroids to try and mature the babies lungs, as well as prescribe tocolytics to slow preterm contractions, especially if these are occurring regularly.

I am also curious to know if your provider has done “stress testing” to assess status of funneling?

Hope this information helps. In the meantime, definitely follow the “strict bed rest” prescription very seriously to give you and your babies the best possible chance of pulling along as far as you can.

It seems like an awfully long time between your provider visits. Even with pregnancies without any particular concerns, provider visits are usually scheduled for once every month to ensure continued good prenatal health. I am not sure why your gap is almost 8 weeks? I would definitely check with your provider regarding this, and question their standards of practice.

Now, especially with regards to your cervical length, it is recommended that you be reassessed every 2-3 weeks (26 mm length). So again, I would question them as to why they are not following research based guidelines of good prenatal care.

In terms of your cone biopsy, it is one of few known factors which may have predisposed you to cervical shortening.

The good news is (and hoping to provide hope to others in the same boat) after a week of strict bedrest, the funnel is still there, but now does NOT open with pressure and is back to 3.1 cm!! I know that could change for the worse again, but this week, I am encouraged.

It was discovered that I had a UTI. I treated over the last week with a course of macrobid. I know UTIs can cause preterm contractions, but could it also change the cervix the way it did?

I recently got a comment from a woman who read my blog, and she said that her cervix (at 19 weeks) was at 11mm and her doctors have recommended bed-rest. She had been very active up to that point, and is willing to slow down but doesn’t want to “stop” totally. She had a cerclage put in. While I’ve answered her to the best of my ability, I know I wasn’t able to help very much. For my own curiosity, I’m wondering what the likelihood that *anything* would help, with her cervix so short so early in pregnancy. Most of what I’ve read says that cerclage and/or bed-rest don’t help much at all, and I was wondering if there was any research done that would be applicable to her.

You are right – with her cervical length being so short, so early, all that can be done is trial of preventative measures such as cerclage and bed rest. I have also not come across any definitive studies that have addressed her particular status.

I am sure that you have come across 2 studies that were done relatively recently:

1. A study done by Daskalis et al in 2006 – Cerclage prolonged pregnancy by 8.8weeks, whereas without cerclage the mean prolongation of pregnancy was 3.1 weeks. However, only 29 women took part in this study.

2. Study done by Pereira et al in 2007: Larger group of women studied. International cohort. 225 women took part in the study, 152 had cerclage placed. They were between 14-26 weeks of pregnancy. Cerclage prolonged their delivery to >28 weeks. They concluded that cerclage led to prolongation of pregnancy, increased rates of neonatal survival and birth weights >1500 gms.

8% of all women naturally have a cervix that is only 8 mm long, and they can carry their pregnancy to term. I hope this is the case with your mom!

I’m currently 22 weeks 5 days pregnant, and had a cerclage placed in week 18. Up until week 18, I had no reason to be alarmed. I haven’t had any uterus/cervical related procedures in the past, but upon going to my ultrasound (at 18 weeks), the technician found that I have a short cervix. Within two days of the ultrasound, I was wisked away into surgery getting a stitch. Mind you, I’m one of 7 sisters, and all of my sisters (besides me) have children. Three of my sisters were diagnosed with a short cervix, and I informed the doctor of my family history; unfortunately, the pattern didn’t click to me…

I had the cerclage on 27 August, saw a high risk specialist (fetal and maternal medicine ob doctor) two weeks later, and was told by him that I must be on strict bed rest and that I should stop coming in to his office. He wished me good luck, and that he would notify my regular OB. I felt…. so low after this appointment, because I believe he gave up on my ability to hold this baby. My cervix was 2 cm at that time, and seriously considering switching doctors and hospitals; as I believe that my regular ob appointments should be more frequent than the normal pregnancy once a month visits. My doctor called me to reiterate the bed rest plan, and said there is nothing else that can be done at this point. Also, she asked me to make an appointment to come in within the next two business days. When I called to make an appointment, the receptionist told me about the times in which the doctor isn’t available, and when I told her that the doctor told me to come in, she said “For What?” Am I being unreasonable to think that my case requires frequent appointments?

1. Your cervical length is short, but I am wondering why the doctor did not want to try you on strict bed-rest first. All research points to <1.5 cm being the mark at which cerclage maybe required immediately. Cerclage carries with it the risk of preterm labor, uterine infection and such – so I wonder why they did not explore the non-intervention option first. However, I am really glad that you have gone almost 4 weeks after cerclage without any more complications.

2. Did all of your sisters with shortened cervix, carry their babies to term without any external intervention (including cerclage)? If this is the case, you may be one of the few people who will carry your pregnancy to term , without any procedures.

3. About 8% of all women have a naturally short cervix ( as short as 0.8 cms) and they carry their babies to term naturally.

4. Although with a cerclage placed, less frequent monitoring (than no intervention) is ok, it makes sense to have you get thoroughly checked every 2 weeks for at least the first month,a and then every 3 weeks or so depending on how stable your cervical length is.

Hope this answers all your queries .. and good luck finding a good OB/hospital.

At 25 weeks pregnant I had pain that appeared to be contractions. Monitoring at the hospital revealed only uterine irratibility and I was sent home and told to drink lots of fluids and take it easy. A follow-up u/s at 26 weeks indicated a short cervx, 0.5-0.6cm. I’ve been put on strict bed rest, was in hospital one week and now at home. No signs of any contractions or uterine irratibility since then. Now at 28 weeks, my cervix measured about the same, 0.5cm. There is funneling though I don’t know how much. I am really scared. This is my second pregnancy – my first was early, water broke at 35 weeks. Is there anything else I should be doing? Any signs I should look for?

You are probably doing all the correct things right now. With your cervical length so short, I can understand why your OB did not want to do anything else. Cerclage could have caused further uterine irritation and premature contractions.

Bed rest and reduced physical activity have helped to keep the cervix from shortening further in some moms. Keep up your spirits and try to relax as much as you can.

Signs to look out for would be 4 or more contractions within an hour’s time – this would indicate preterm labor.

At 24 weeks (3-Oct) my cervix had an opening from inside(funneling). After funneling my cervix length is 1.87 cm. Tomorrow, I am going for Fetal Fibronectin test though i have no vaginal discharge. Since Friday (3-oct) i have been on bed (anti gravity) with getting up only for toilets. I am extremely extremely worried as I am carrying fraternal twins. …..What are my options ?.
(1) Do you think I should talk to doctor about Cerclage
(2) Or may be hospitilazation ?

Also, I am feeling localized hardening of my tummy which goes away very quickly. Their is no pain. This happens around 5-7 times in a day. I was ealier thinking it might be some baby part, but now I am thinking this could be contractions. Do you think this is Braxton Hicks ?

Sorry I could not respond earlier. The correct choice of treatment is strict bed rest in your case, especially since you are carrying twins, and so would have greater pressure against your cervix. I am not sure whether your doctor will recommend cerclage, since your cervical length is pretty short, and you do not want to risk too much uterine irritation.

If you can hang in there with STRICT bed rest until your 28th week, then monitoring you on a weekly basis, and perhaps administering steroids to mature your babies’ lungs will help to take you and your babies forward from thereon. If you think remaining at home will not let you maintain strict bed rest, then you could think of hospitalization. However, remaining in the hospital presents risks of hospital-based infections, and this is something you should be aware of. It would be best if you could get someone to help you, and be around you at home.

As far as the tightening of portions of your stomach, it could be Braxton Hicks, or it could be premature contractions. What did your OB find at your subsequent check up, and what was the result of your fetal fibronectin test? Both of these would indicate how to proceed with your care going forward.

As you said, Cerclage was ruled out because i am too far into pregnancy.
The fetal fibronectin results were negative. I was kept for 1 day in hospital for monitoring. They already went ahead and gave the steriod shots. Terbutaline (5mg) was given every 4 hrs (while in hospital) to stop the contractions. It did stop the contractions, though it was causing my pulse to go beyond 120. Now i am bk at home with a reduced strength of Terbutaline (2.5 mg). This is helping me with my pulse rate, but the contractions have started and it keeps coming & going. It is spread around with no fixed patterns. In 1 hr i had live 4 but in total i had like 7 in the last 5-6 hrs.
A monitoring machine has been placed at my home, but they would not panic until its like 6 in an hr….

I don’t know what to do now ? We have next appointment with OB in 2 days time. What would you advise ?.

I am currently at 29 weeks. My cervix length was measured as 1.8cm and 1.5cm (to confirm the first measurement) at 28 weeks, but no funneling and with negative fFN. Is this a very short cervix length? I am very healthy and has no miscarriage history. And this is my first pregnancy. As early as 17 weeks, I had contractions (no pain). Since 25 weeks, I had a couple of times frequent contractions without known reasons. Now, I am following my OB’s recommendation, doing bedrest, having internal check every week, and having fFN every two weeks. I still have contractions from time to time, but not too often. And OB has already given me steriod to help baby’s lung grow.

Doctor, I am wondering if cervix shortening is related to contractions. Is it possible that one causes another one? What can I do now besides bedrest? Do I have great chance to hold the baby till the full term? What can I do to avoid this in my next pregnancy?

I am hovering around 3.2 cm, and the OB is very happy with it. But I’m not so confident in the older woman who has been doing my u/s. When the specialist was doing them, she would push on the fundus or have me bear down to get the true measurement. This other lady at the regular OB office is not having me do that.

Should I ask the older lady to take the picture when I bear down a little to see if it’s opening with pressure?

I assume we should be encouraged at the holding steady at 3.2 at 24 weeks!

I think you are pretty much doing all you can. Terbutaline acts by trying to relax the muscles of the uterus. While it can temporarily decrease or even stop preterm contractions, it may not be able to stop preterm contractions indefinitely. So you and your OB will have to just wait and watch (as you are doing now). Having the monitoring machine at home will be helpful to get you to the hospital quickly, in case your number of contractions per hour suddenly increase.

Keep up your patience with this … you will be needing a lot of it, as well as good, positive, supportive people around you. At the risk of sounding “non-medical” I would advise you to try meditation and relaxation. Pregnancy is as much a psychological process, as physical. In addition, relaxation techniques , breathing, meditation etc. are known to provide muscular relaxation – and the uterus is a muscle. Listen to some soothing music. Finally, try deep breathing. Imagine the air going into your lungs, and reaching in all the way to your uterus in the front and tail-bone in the back. Then exhale out slowly, as if imagining that you are blowing a candle that is far away (maybe an opposite wall). Do not hold your breath at any time. This kind of breathing is very calming, and can do wonders. If nothing else, it is delivering good clean oxygen to you and ultimately your babies.

Please do not hesitate to write back – you can definitely use me as your “virtual” support system. If you would like to communicate personally with me, you can always write to vsakotai (at) yahoo.com

Yes, your cervical shortening is probably what is causing those contractions. Having said that, not all expectant moms with a shortened cervix will have preterm contractions.

You are probably doing all you can. You should continue to be on strict bed rest. And steroids have been given to mature your babies lungs, so that’s one part of the equation that has already been taken care of.

On the positive side, you are not having too many contractions, and have negative fetal fibronectin test results. Added to that you are at 29 weeks, so I am hopeful that you will be able to cross your next pregnancy milestone – which will be 32 weeks. After that it will be wait and watch – and each week that you go forward will be an added bonus. Be patient, and keep a positive frame of mind.

I am not sure you can do anything to prevent this in your next pregnancy. There is nothing wrong that you did in this one either. This is just one of the concerns some women have to face in their pregnancy. Having said that, some women carry their pregnancies to term with lengths that are shorter than yours! So let’s hope for the best in your case as well. And, who knows, in your next pregnancy this concern may not arise at all!

Keep up your spirits, and all the patience that you are showing as you go along.

I am very glad for you – Yes, you should definitely feel encouraged that you are holding on at 3.2 cms :)

Have you asked the other lady who does your ultrasound why she is not applying pressure on the fundus to check for funneling? I am not sure whether you want to bear down when the specialist is not there with you – your effort may be wasted, if this other lady does not know what she is looking for. And, if she is not comfortable with applying fundal pressure, you can perhaps let your specialist know about this, and she can check you every other time? Or she can communicate what your check up needs are better to the regular US lady. I think this would be the safest thing to do.

Thank you for communicating your encouraging results here – I think it will give heart to a lot of the other moms who are in similar situations as yours :)

Hi there. I was just diagnosed with a cervix that is 0.8 cm in length with no funneling, but dialated 1cm. i have been put on moderate bedrest with weekly appointments to keep an eye on my cervix, as well as nightly vaginal inserts of progesterone. Do you think I have a chance of holding this baby much longer? I feel like alot of the stories I read are women with ICs that are around 2cm. I am really scared and want an opinion on my chances of carrying this baby and how long?
Thanks,
Wendy

With your cervix length being so short, there is not really any definitive research which suggests that any stricter bed rest will help. If you were perhaps slightly earlier in your pregnancy, cerclage might have been an option, but even then there have not been many studies showing either major positive or negative effects on carrying pregnancy to term.

I think you should be ok with your current out of bed schedule. Do try to strictly adhere to it. No straining at stools, no activities that involve increase in intra-abdominal pressure, such as lifting. In terms of sitting on your couch, I would not recommend it if it is low. When you get off it, you will certainly increase intra-abdominal pressure, which is not advisable. If your couch is high, if it can recline/semi-recline and/or you can make the sitting surface higher using some pillows, it might be ok to use occasionally. If you do increase the height of the sitting surface, you may want to make sure that your feet are still supported – if you need to put a small wedge/stool under your feet. That way, you will still have a good sitting posture and will not end up with a backache.

One more thing I forgot to mention in my post yesterday – a better way to check for funneling would be to have you cough. This is better than asking you to bear down. You can perhaps check with your specialist re: this?

[…] avoided in retrospect, but at the time they were not able to have been avoided) — such as incompetent cervix, in which mothers and doctors tried to avert a preterm birth using every way they could, to no […]

Hi,
What a great summary. Very succinct.
I was found to have cervical insufficiency with my first pregnancy at 21
weeks. My cervix measured 1.6cm, and funnelling was detected.
I was placed on strict bed-rest (only got up to pee, seriously) by my MD,
and he avoided a cerclage procedure. I was monitored weekly with
ultra-sounds until 34 weeks, and my cervical condition did not change. I
went off bedrest at 38 weeks, and delivered my healthy daughter (7 pounds,
14 ounces) at 40 weeks (full-term), with a long labour that lasted 14 hours.
During the pregnancy, at the 24 week mark, we had discussed steroid therapy
with my doctor, but never proceeded with any medications. Everything worked
out well!!

Well, I am know pregnant with my second child. My first MD retired, so I am
under the care of a new physician. Because of the full term pregnancy, long
labour and realtively big baby, he was initially reluctant that my cervix
was insufficient, probably just short he believed.
He did start measuring my cervix at 18 weeks, with weekly ultrasounds.
He did not think cerclage at 13 weeks was necessary. My first three results
were solid, cervix measuring 3.0cm. At my 21 week test, my cervix was
measured at 2.0 cm, and severe funnelling detected. My doctor wanted to
proceed with cerclage that day, but my husband and I were reluctant because
of the risks involved. He was very understanding, and sent me home under
strict bed rest to be re-assessed in 3 days. The next ultrasound my cervix
remained at 2.0 cm, and the funnelling dissappeared.
He recommended continued bedrest, and to monitor my cervix in two weeks. He
did not recommend cerclage at this time, saying that the bedrest seemed to
be helping things. I am now 23 weeks pregnant, and on strict bed rest. I
just saw my doctor two days ago and my cervix looked unchanged, and no signs
of funnelling. I am going back in two weeks for another ultrasound. So far
things seem to be repeating as my first pregnancy. I am very happy with my
physician so far in terms of the treatment I have been recieving and his
opinions. My question is, in your opinion, am I at a greater risk for
pre-term labour the second time around? should I consider any other
interventions? would steroid therapy be highly recommended, or not necessary
as it was avoided the first time around? and what would you recommend the
course of action should be for my next pregnancy?

Hello. I am currently 24 w 5 d. I had a cerclage put in around 18 weeks. At my one week check up after the cerclage, my cervix was 4 cm. As of 24 w 2 d, my cervix was 1.12 cm. My doctor sent me to the hospital where they gave me steroid shots to help the baby’s lungs. I was only in the hospital for 24 hours or so. After my release, I was put on modified bedrest until my next appointment which was about 5 days away. My doctor is saying that I maybe able to go back to work or do a modified schedule of working from home some days and working some days. Is there anything else that I can do or that I should recommend to the doctors? I want to make sure that I have all of my bases covered.

Being that I have a cerclage, does this put me in a different category and I should worry less. The reason why I ask, my maternal fetal specialist sent me home after telling me that cervix was at 1.12. Luckily, I had an appointment with my OB immediately after that who sent me to the hospital.

I too would have been inclined to believe that you just have a short cervix and not cervical insufficiency. However, with the funneling that showed up on your 21st week US, it points to some measure of insufficiency.

With your history of carrying your first child to full term, and then having a length of labor which would be in the normal range, I feel that you will probably have a repeat of the same again. Your labor may be shorter though .. and won’t that be great :)

You probably took the right decision in not going in for a cerclage, especially as you had crossed 20 weeks; strict bed rest is the only treatment of choice at this time. Regarding steroids, my sense is that you could still afford to wait for some time. If there is any further shortening, you may be at risk for preterm labor, and in this case, you could probably go in for steroids. If you continue to maintain your cervical length (as you are doing now), you may not need steroids at all.

As for you next pregnancy, it may be worthwhile exploring the option of preventative cerclage. Not so much because of risk of preterm labor, but just so you don’t have to be under strict bed rest, and can actively enjoy your pregnancy. Typically if done early enough (13-16th week), after being on bed rest for 2 weeks, and being monitored, preventative cerclage will let you be mobile and active for the rest of your pregnancy.

Occasionally, it does happen that cervical length decreases even after cerclage has been put in. However, since cerclage is protective, cervical dilation and premature delivery should be less of a worry for you. This is probably why the maternal fetal specialist sent you home. Having said that, your OB probably did the correct thing to get steroid shots administered to you, as there is no way to predict whether or not you may still go into preterm labor.

Modified bed rest, and not doing any activity that increases intra-abdominal pressure would be appropriate in your case. I would also recommend least possible travel (even to work), at least for 2-3 weeks. After this, if your cervical condition remains stable, you can probably resume a little more travel and out of bed activity. This will also get you to your 28 week milestone.

The reason for the 28 week milestone:- with the steroid shots the baby’s lungs will be relatively mature for survival outside of the womb. This is in case of preterm labor only. Otherwise, you may well carry your baby to term (as may of my moms have) – your OB will usually remove your cerclage at 37 weeks and wait for your labor to start.

Hope this helps .. if you have any further questions or concerns please feel free to write in.

I am 23 weeks pregnant today. At my last OB visit my doctor informed me that my cervix was 1.9 cm. I have to see him now every week. There was also some slight funneling present. He did not put me on any kind of modifications or restrictions. Everything that I read says that I should be on some type of bed rest. What do you think. I have an appointment next Thursday and would like to know what to ask when I go in.
Renee

I am surprised that your OB did not put you on any type of precautions/bed rest. With your cervix measuring around 1.9 cms, research indicates the benefits of bed rest in limiting further shortening. In fact, in the past, many of my moms have shown some improvement in their cervical condition with strict bed rest.

Definitely do ask your OB what his rationale is behind not putting you on modified activity levels.

Hi Dr. Vijaya,
I had previously written you with a short cervical length of 8mm. I have still remained the same and taken your advice about the strict bedrest instead of the modified. However, I now have funneling in a u shape that I did not have before and yesterday was told that I now have polyhydramnios at a level of 30. I did not know what that really meant yesterday when I was there-they told me the baby was healthy and it was of no threat to the baby. Since I have been home I have read different and feel my chances of preterm delivery are so much greater now! I am 26 weeks today and so scared for my baby! What do you think my chances are of making it to at least 28 weeks with a healthy baby?
Thanks,
Wendy

Thank you so much for your comments last time. Your words are always so clear and encouraging, which really relieved me a lot. Thank you!!

Unfortunately, I met the new issue this week. I started to do bedrest since 28 weeks due to the short cervix and had weekly check since then. Nothing changed in 29 and 30 weeks. But in this week, i.e., 31 weeks, the doctor found that the cervix is dilated by 1cm and her description is 1cm/80/-1. I think 80 means effacement is 80% and -1 means baby position is low. Is it right? Given my short cervix (1.8cm from one ultrasound check, 1.5cm from another ultrasound check), do you think how long I can hold my baby? My baby is only 3 pounds 6 oz at this moment. I really wish I could hold him a little bit longer. Based on your experience, do I still have great chance to hold till 37 weeks? By the way, I still have contractions, but not frequent and no pain.

Look forward to hearing from you soon, doctor, and thank you in advance,
az

Polyhydramnios is increase in levels of amniotic fluid that surrounds your baby. Normal levels vary greatly – with a range of 5 – 25 being normal. So, 30 is on the upper limit, but it would not have been that much of a concern if your cervical length had not been short.

The increase in fluid levels is probably putting more pressure on an already compromised cervix, and that may be part of the reason behind your funneling.

Just remain watchful for preterm contractions .. if you start having any, it is time to get to the hospital and get yourself checked immediately.

Hang in there … you are doing all that you can possibly do. Every week that goes by makes your baby a little more developmentally mature; You will just need to remain patient and wait to cross the 28 and 32 week milestones.

You are correct in reading your cervical measurements – it looks like your cervix is 80% effaced (thinned out) and that your baby is moving lower into your pelvis. I wish I could tell you how long you can hold on … no two moms are same, and even delicate changes in hormonal balance can set off changes leading to preterm labor. In your case, the good news is that your contractions have not increased in frequency or intensity. I am hopeful that you can carry on for at least a bit longer.

In terms of your baby, by 32 weeks the baby is almost fully developed, and is performing rhythmic breathing. But this is still practice breathing, and the lungs are not fully mature as yet. However, with steroid shots (I am sure your OB has already given them), the baby can survive outside of the womb. The baby has 95% survival chances if born now. And, with good intensive care, there are very few chances of any long term complications. Also, know that you can still interact with your baby, touch your baby, massage your baby and talk to your baby even if he is born now, and needs to be in intensive care nursery for some time. Do take this time to find out your hospital protocols regarding whether/for how long they allow parents to be with their babies in the nursery. Research has shown that premature infants who are touched and massaged for 15 minutes, 3 time daily, have less complications, and are discharged home up to 6 days earlier than those who do not get this kind of interaction.

Yes, you do want to hold on for as long as possible… this is to let baby add all the fat he needs at birth, and so all his organs can mature and function effectively, and so he can breastfeed without difficulty.. .. so, continue being on strict bed rest, and keep up your spirits. Next milestone to look forward to would be 32 and 34 weeks. After that each day you can hold on, would be a good bonus.

I can share with you that my older son was born by emergency c-section at 35 weeks and 6 days. He is 10 years old now, and doing just fine :)

I really appreciate your prompt response. Yes, I had two steroid shots three weeks ago, so doctors said there is nothing we need to do, but just wait/monitor at this moment. I guess nothing I can do now but do bedrest and cross fingers.

I am 21wks pregnant with my 3rd child. My 1st was born at 31wks and with my second they were monitering my cervix and at 21 wks with a shorten cervix of 15mm they put a stitch in, I then went on 2 40wks and had to be induced. Now with my 3rd at 21wks my cervix was 25/28mm with slight funneling, they didn not want to put a stitch this time saying my cervix is not showing of one which is incompitent and they just want to continue monitering me. Should i insist on having a stitch before its to late, I dont no what i should do. Thanks Shivon

My question to you is: are you seeing the same provider/practice that you went to in your last two pregnancies? If so, I would be inclined to go with their judgment.

Usually, previous preterm deliveries and tendency to cervical shortening, would be a good indication to put you on preventative cerclage. However, this is more effective (and less risky) if done between the 13th-16th week. Because that time has come and gone, in your case, the better option right now would be to wait and watch, because the cervix is showing only borderline shortening. I am slightly concerned about the funneling, but hopefully is your cervix does not show any further signs of shortening this should not be too much of a concern.

If it is the same OB/practice that saw you in your previous deliveries, they would have a good idea about your overall condition and tendencies, and my suggestion would be to go along with just monitoring for now. If not, then you can monitor for a week or so more, and if further shortening occurs, then you can ask for a stitch to be placed – that way, you won’t be too late.

Hi there Doctor! Hopefully you can answer this question for me before Wednesday. I had my first ultrasound 2 Fridays ago. I was told I was 7 weeks at this time. It was discovered that my cervix is on 2.7 cm long. The PA wants me to have another ultrasound this Wednesday to double check and THEN if they still come up with that length they want me to go to a specialist because their equipment is better to triple check. I’m not sure if this is necessary as back in 01 I had a leep and .3 cms of my cervix was removed. I found this paperwork last week and gave it to my doctor’s office. Do you think it is necessary that these additional ultrasounds be performed? My insurance isn’t the greatest and I don’t have money to be throwing away when we already know that I am short.

Any input/advice you may have would be greatly appreciated! Thank you, Lisa

hi dr
i am 22 weeks pregnant today and i went for my Anomaly scan today, everything with the baby is great but they looked at my crevix and it measures only 15mm, im very worried they said it should be a minimum of 25-30mm. because i was so worried i didnt ask any questions about it i just wanted to get out the hospital, im just wondering are my chances high at having a premature delivery this is my 4th pregnancy, i had 1 termination 2 years ago and i had a miscarage this january and another in april, im very worried about this baby

Hope this information reaches you in time for your doctor’s visit. I am sorry it took me a couple of days to respond – it is festival season here in India, and I did not log on for a couple of days.

To answer your question, since you already know that your cervical length is on the shorter side, it makes sense to keep monitoring on a every two to three week basis. And if the length keeps decreasing, then you are probably better off in deciding a course of action at that point of time. Since you are only 7 weeks pregnant, and since your length is borderline short at this point, research shows that it is better to adopt a wait and watch rather than do anything right away. If in 2 weeks time, there is dramatic reduction, it would still be early enough in your pregnancy that one can opt for cerclage. On the other hand, if there is only marginal/no reduction, one can assume that you can safely be just on monitoring, and perhaps you can even carry through your pregnancy without any intervention, cerclage, rest or otherwise.

In terms of equipment, I am not sure what additional information it would give? I think it depends on the skill of the person doing it rather than the equipment. And, sometimes just having a full bladder before getting your ultrasound done, will give a better reading than any special kind of ultrasound. You could check with your PA’s office and ask them, what kind of specialized ultrasound are they looking for and why.

Hope this helps .. if you have any other questions or concerns, please feel free to write in.

It is hard to pinpoint and say what your chances of premature delivery are at this point. Since you are at 22 weeks, cerclage may not be an option. However strict bed rest and monitoring on a weekly basis would be highly recommended – and many moms are known to carry their pregnancies to term, or close to term, with this alone.

I am sorry to hear about your previous miscarriages. I would like to know if they happened in the first or second trimester each of the times? If they had happened in the second trimester or “late” first trimester each time, it would have been good with that kind of history, if your OB had advised you to go in for a preventative cerclage.

Having said that, try not to worry – I know this is easier said than done. But, try and focus on getting through each week. That way, you are looking at weekly milestones rather than focusing on all that can go wrong in the rest of your pregnancy. The first milestone that you want to get to is 28 weeks .. at this point (you will be given steroid shots) your baby’s lungs will be relatively mature.

Hello Dr. Vijaya.
Thank you for sharing your expertise on this sight. It is the most helpful forum I have found on Cerclage.
I am just over 14 weeks pregnant (12 weeks gestation), and I am scheduled to have a cerclage done at the end of this week. Though I do not have the exact measure, my doctor assures me that my cervix looks perfect. My history of miscarriage is why he leaned toward using a preventative cerclage on me.
This is my 6th pregnancy. The 5 previous pregnancies were all early miscarriages, save 1–my second pregnancy. This one resulted in a loss at 5 1/2 months. Unfortunately, I was with another doctor at that time, and I have no concrete diagnosis as to the cause of that miscarriage. It is assumed however that my cervix was compromised by the presence of several large fibroids that were in and around my uterus. I think they assume I had a painless dilation since there were no contractions or warning signs.
The fibroids were all successfully removed 2 years ago. I am also taking Lovenox coupled with a daily baby aspirin to prevent any blood clotting. (I was diagnosed with a potential blood clotting issue recently that might be the cause of the early miscarriages.)
From the recommendations you gave in the article published at the top of this page, I am assuming that you would not have felt a cerclage was needed in my case. Is this true?
And do you believe that bed rest is needed in my case? My doctor has said I do not need that after the first few days following the procedure.
Lastly, do you believe that airline travel is a risk for me based on my circumstance.
Thank you so much. Alexis

What a wonderful website you’ve put together – with such thoughtful questions and responses. I found everything really helpful, but didn’t see an answer to a question that I had in my mind. My Dr. doesn’t seem to have an answer either…either that, or he believes I shouldn’t be thinking too much about this – which might right!

In any case, what I wanted to know is what is the normal rate at which the cervix begins to shorten? I am 21 weeks pregnant now. One month ago my cervix measured around 5 cm, but last week it measured closer to 4 cm. I don’t know enough about IC to know how it happens, or how quickly. I think I’ve lost nearly 1 cm – perhaps a bit less – in a month. Is that ok? Will I continue to lose at that rate, or could it accelerate? I have another appointment at 24 weeks, at which time he will measure the cervix again. Should I just relax until that next appointment? I would just hate for something to happen within a month that could be prevented with more careful monitoring.

Not normally neurotic, but somehow still have a lot of questions about this topic.

To the contrary, I think that what your doctor is suggesting is probably the best course of action in your case. Granted that we do not know the exact cause of your previous miscarriages – it could have been a combination of your uterine fibroids, clotting disorder, and or compromised cervix. Although evidence does not exist in favor of placing cerclage for previous first trimester miscarriages, it is definitely better to treat unexplained second trimester miscarriages by preventative cerclage.

Following placement of cerclage, it is recommended that you be on bed rest or modified bed rest for around 10-20 days. The time that you are asked to be on bed rest will depend on the particular obstetrician. After this initial phase, you can go on with your regular activities. Most doctors will still ask you to avoid much lifting, or anything that causes an increase in intra-abdominal pressure.

As far as airline travel goes, you would need to follow the same precautions as any pregnant mom, and not fly after the seventh month. Other than that, nothing related to your specific circumstance/cerclage should impact greatly on your air travel, especially once you are through with the initial phase of bed rest.

Overall, I think that your plan of care is correct based on my understanding of your circumstances so far. Once initial phase after the cerclage is past, you can enjoy the rest of your pregnancy, and wait for the stitches to come off at week 37. Hope this helps ….

Dr. Vijaya,
Thank you so much for your thorough and prompt response. I will go into surgery confident that this is the best course of action for me, with your valued second opinion. And I’m moving ahead into this next phase of my pregnancy filled with the hope that this will be our first child.
All the best to you!
Alexis

Dear Dr.Vijaya,
Thank you very much for sharing your experiences. Reading your responses have given me some insight. Iam 20 weeks and 3 days pregnant today. This is my second pregnancy, my first ended with a miscarriage at 6 weeks(cause:blighted ovum). Today, The doctor told me my cervix is 2.6cm,which is on the low range and that my cervix is closed. Is this something to worry about, that my cervix is in the low range? Am i at risk for premature labor. He only told me to come in for a followup ultrasound in 4 weeks. I will appreciate any advice you may have on this. Thank you so much

There are not a lot of studies out there which tell us the normal rate of cervical shortening. The cervix starts to change and shorten in the second trimester and carries on all the way to delivery.

There was one study done in 21 healthy first time expectant moms, who gave birth at term. The women were examined every 2 weeks by transvaginal ultrasound from 24 weeks till delivery. They found that the average length of cervix in these women at 24 weeks of pregnancy was around 41mm (4.1cm) and it decreased to an average of 2.9 cm before delivery. However, there was variance in the rate at which this shortening occurred. While the shortening was steady and continuous, at an average rate of 1.1mm per week (range 0.6-2.4 mm) in 12 women, in 4 others the shortening occurred only at end of term, with rapid shortening of 3 mm per week. 5 women did not have any shortening until labor and delivery. (Source – Acta Obstet Gynecol Scand 2002)

As you can see, even in normal there seems to be a wide range. However, the study was small, and we do not know how applicable it would be to the population at large. Having said that, with your cervical length being around the 4 cm mark, you should not be worrying too much. I would suggest that you wait until your next scheduled check up. If the length remains the same, or it shortens slightly, you will not need to be continually monitored. If the length shows more rapid decline and if it touches around 2.4-2.6 cm, then you will need careful monitoring every 2-3 weeks or so.

At 20 weeks, 2.6 cm length of cervix is at the lower range of normal. Nothing to worry about yet, though. It might be worthwhile getting monitored by your doctor, every 2-3 weeks, rather than wait for 4 weeks. That way, in case there is a more marked decrease, you can be started on limited physical activity earlier, than if the change were picked up later. You can suggest to your doctor, that perhaps you could re-schedule your follow up at the 3 week mark, rather than 4 weeks from your last appointment.

It is too early to worry about premature labor. A lot will depend on what, if any, changes are there in the length of your cervix in the coming weeks and months. Depending on this, you follow precautions, that seem to be helpful in decreasing chances of premature labor.

Thank you so kindly for your prompt and thoughtful response. The research and information you provided was immensely helpful, and I feel I can relax a bit and just wait until my next appointment to revisit the issue.

hello my name is sarah. I have been put on bed rest because of my cervix being meassured at 2.3 cm at 25 weeks. I am very nervous. This is my first pregnancy. Do you think i will go into pre term labor? What are my chances of carrying full term. What are other options besides bed rest. I dont know what to do. Please some advice.

I am thrilled to have found your board but not so thrilled that I am in this cervical dillema. I am 30yrs old with first pregnancy at 16 weeks and am high risk because of thrombophilia (taking blood thinner) and crohns disease (in remission thank God – no meds). I had no issue conceiving but yesterday at my appointment doc told me and my husband that my cervix went from 38 mm to 30 mm in a 2 week period. Visibly concerned, he put me on modified bed rest and will examine me next week. Hopefully I won’t need a stich.

I am afraid. I am so early on and in fear of preterm labor. Could the shortening stop or progresss extremely fast in one weeks time? He mentioned that it could go back to normal (i.e. may have been caused by dehydration, inflammation, or stress), is this possible? Also, are there signs of cervical shortening, like pain or discomfort, if so I have had no strong feelings of either.

The shortening that you have had over a two week period is rapid. However, no two moms are the same, and your cervical condition may show stability at your next check up. You can go through my response to Karin (Nov 12) for a study that I have quoted there, which shows average shortening of the cervix after 24 weeks.

In your case, it is very early. That it has been discovered may be a blessing in disguise. If your cervical length continues to shorten rapidly, then cerclage may be a better option, than to wait until it shortens to such a length where you may need to be on complete bed rest. If it stabilizes, then you can quit worrying, and go abut your pregnancy without further restrictions.

Dehydration, inflammation, stress etc are not known factors to cause cervical shortening.

No, there are no physical symptoms of shortening. It is only something that is discovered by physical/ultrasound exam.

The cervical length of my wife is being measured @ 2.8 cm after 19 weeks & 6 days of pregnancy. The Doctr has asked to visit for another ultrasound after a period of 3 wees plus to monitor the size of the cervix. Kindly advice if this is noral as she has mentioned that, it may lead to delivery prior to the actual time. This has created a concern in the mind of my wife, however, request you to kindly let me know, if this is serious and will have any problems in the future…

2.3 cms at 25 weeks is on the borderline for cervical measurements at 25 weeks. Modified bed rest (no physical exertion, no stair climbing, no lifting, no straining at stools) is probably the best option to manage the condition.

Check up with your OB/GYN every other week is very important to monitor your condition as well.

Finally, there is no way to tell if you will go into preterm labor. However, if you take the advice of bed rest very seriously, you should be able to carry on with your pregnancy – take each week as it goes. Take heart though – most moms who carry forward to 32 weeks, are able to take their pregnancy to term. And in your case, the shortening is only at the lower end of normal. Many moms have carried through most of their pregnancy with 2 cm or less, with good support, and strict bed rest.

I am at the age of 35 and in my 27th week of twin (also first) pregnancy. At 25th my CL was 42 mm and two weeks later (by the start of my 27 week) it has been measured as 30 mm. 5 mm per week shortening. My next visit to OB is after 3 weeks. My question is do you think 5 mm per week is an ongoing thing (I read that 0.8 to 2.9 mm per week is normal) if so at my next visit I will have around 20 mm by week 30 and will be in the risky position (?!). No special care has been asked from me – I go on normal living and working. If I will be in risky case I want to start taking precautions from now (like reduced physical activity or resting). Thanks in advance for your concern, Best regards Sammy

The shortening within a two week time period in your case, has been remarkable. However, if at your next check up, it stabilizes, you don’t have to do anything further. In case it continues to shorten at the rate it has done so far, you would need to be on bed-rest.

I do not think you need to do anything particular right now, as we need to figure out how your cervix behaves with normal physical activity. If it shortens further, a trial with decreased activity can be tried at that point.

Dear Dr. Vijaya
My wife is 21 weeks pregnant and her 5 month ultra sound revealed her cervix was 1.4 – 1.5 cm. After the ultrasound her OB has put her on bedrest. I was wondering if there is something that can be done to prevent the cervix from shortening.
Her Ob had put her on progestrone since 3rd month. Also she went into preterm labor in her first pregnancy at 32 weeks. Please advice.

Bed rest would be the only way to manage your wife’s cervical shortening at this point.

I am just wondering if you are seeing the same obstetrician for your second pregnancy as your first? The reason I ask is because of the preterm labor the first time around. In cases of unexpected second or third trimester preterm labors/losses, it would have been an option to look into early cerclage (13-16th week), after which, your wife could have gone along her pregnancy with being monitored intermittently. Since she has been put on progesterone, am I correct in thinking that it was because of your wife’s previous history of preterm labor?

In any case, now, it would work greatly to your wife’s advantage, if she could be on as complete a bed rest as she can. She can and should do gentle arm, leg and foot movements, 1-2 times a day, just to make her feel better, and as well as to maintain good blood circulation.

Dear Dr. Vijaya
Thanks a lot for your earlier response. To answer your question, we are seeing a different OB/GYN + a High Risk Pregnancy specialist this time. And yes, the progestrone is to prevent her from going into pre-term labor. Do you think progestrone will really reduce the chances of pre-term labor.

Her OB/GYN thinks that by stiching the cervix at this stage it would increase the chances of pre-term labor. Her OB/GYN had studied her 1st pregnancy file and I remember her saying “First time u delivered pre-term because u went into labor & not because of weak cervix+ that you had a good outcome first time”. Also my wife was told that at the first sign of contractions/labor she will be give some kind of tycoloctins (not sure of this word) to prevent the contractions from kicking in.

Progesterone does have some effect in sustaining pregnancy – as to how much it can prevent preterm labor, the research is not quite clear. However, under the circumstance, progesterone would be the only option in your wife’s case.

I do agree that at 21 weeks, cerclage (stitch) would not be recommended, because with the growing uterus, the chances of uterine irritation and premature labor are greater. However, with the previous unexplained preterm labor, I was just wondering if cerclage would have been a viable option if thought of early enough – around the 13th week itself.

In any case, since you and your wife have long crossed that point, I think that you and your obstetrician are doing pretty much all you can. Please tell your wife to monitor herself regularly – both for fetal movements, and for signs of premature labor. Anytime, she experiences more than 4 tightenings/contractions within one hour, it would be a good idea to get checked by your OB immediately. She will then most likely be put on tocolytics – which are uterine muscle relaxants. They can decrease chances of premature labor.

Hope this helps .. please write in, if you have any other queries/concerns

I am in 19 week pregnant and this is my second pregnancy. My first pregnancy was induced at 42 weeks my daughter was born after long prolonged labor. I realised that my body metabolizes faster than averge after my daughter had to be rushed to ER since she was non responsive when I was on painkiller Percocet.

This pregnancy, I had polypectomy at around 8 weeks and I had mysterious bleeding (with mucous) around 12 week. The ultrasound performed immediately could not trace the cause and the fetus as doing good. My obgyn did not worry about it after reading the results of ultrasound.

Now, in 19th week ultrasound, they found that my cervix has shortened and measured 24 mm. I am put on bedrest and on ibuprofen 600 mg X 4 times a day. I am scheduled for follow up ultrasound next week. At this point of time, I am not able to differentiate between contractions and baby movement, but i can feel that there is lot of movements going in there :)

What are the chances that I can make this time to full term? Also, keeping in view the effect of painkiller on my new born last time, I am very much worried about taking ibuprofen now. I also see articles on the internet about harmful effects of ibuprofen on the baby. I am worried sick now.

In continuation of my previous post above, I forgot to add that in both of my pregnancies, I was on Prometrium in first trimester as I have a history of hormonal imbalance. Thank you for looking into my issue.

I have a few of questions for you, before I am able to answer your queries completely:

1. In your first pregnancy, was Percocet given during labor? And how long was your labor? What medications were used for induction?

2. In your current pregnancy, where exactly was the polyp that was removed? If it was near the cervix, then that might have have been a predisposing factor as far as your cervical shortening is concerned.

Now, good news is that you are feeling a lot of movements – and that is great!

However, I am not convinced about the Ibuprofen protocol. There is no research which shows Ibuprofen as an effective line of treatment for cervical shortening. In fact, there are zero medications shown to be effective to either prevent or decrease the rate of further shortening. One of my colleagues who occasionally uses Ibuprofen (not for cervical shortening, though) is very wary of using it without proper monitoring. In fact, she usually monitors the patient daily, and slowly increases the dosage. I will get a second opinion form her regarding your specific circumstances tomorrow, and send in another response to you. In the meantime, please follow your maternal instincts (which I believe are very, very strong – and probably the best way to keep in tune with your body) and if the fetal movements are very rapid, or if you feel uncomfortable or feel “not quite right” – for lack of a better clinical term, you should probably get yourself checked out by your OB.

Treatment for your hormonal imbalance in the first trimester was probably needed, and should not have any effect as far as your current cervical shortening is concerned.

In your case, with a 24 mm cervix length, all research indicates that you can be on reduced physical activity and can get repeat measurements done every 2 weeks; complete bed rest at this stage is not really needed.

Hope this helps to some extent.. I’ll post another response after speaking with my colleague tomorrow.

Thanks for your quick response. The are the details to help you in helping me:

1. I was given pitocin for inducing labor. I had epidural when I had dialated almost 7 cms and it was stopped during pushing phase. The total labor was for 13 hours out of which I was in pushing phase for about 4.5 hours. I was given percocet immediately after my first delivery as I had around 14 stiches due to episiotomy. I was also put on antibiotics (my newborn too was put on antibiotics on safer side) due to chorioamnionitis which might be possibly caused by frequent internal monitoring and/or due to meconium staining of amniotic fluid. The doctors in NICU as well as my Obgyn refuse to relate my daughter’s non responsive condition to percocet saying its a very safe medication. But, owing to nursing problems, I had consulted a lactation consultant who said she had noticed percocet causing similar issues before. Only a few months back a medical warning was issued relating Percocet with faster metabolism and harmful effects on breast fed babies.

Also, within weeks of my first delivery I also developed polyps along the episiotomy area which were removed externally and almost a year later due to pain, hysteroscopy was performed to remove some more polyps near cervix. I was told by then obgyn that I have real sensitive organs when I requested for an IUD to be placed and doc declined saying that she feels I am not right candidate for placing any external foreign bodies inside me.

2. This pregnancy, I had spottings regularly in the earliest stages and my obgyn (different one as we moved to diff state) found polyps near cervix and removed them. These polyps seemed to have formed due to hormonal changes during onset of pregnancy as I had an ultrasound peformed a few months before pregnancy to check whether there are any new polyp growth or not (I wanted to be sure about them before I was going to try to get pregnant!) After a month or so, I was nauseated while cooking and as I was vomiting, I had vaginal bleeding (with something like thick mucous plug) . An ultrasound (pelvic and not transvaginal) and phlysical exam was perfomed which showed no issue with cervix and with fetus. So, it was assumed that the bleeding was mysterious and I should not worry about it as baby was doing fine.

I am worried about Ibuprofen especially after knowing how I nearly lost my first baby due to Percocet. I know those are totally different drugs, but still I don’t know how my body treats them and pass it on to the baby. My obgyn says this is the usual protocol and asks me to give it a try atleast for a week. The other issue bothering me is the Cerclage as I do believe that my system is not going to handle that well. But, do I have any other option as my only priority is saving this child and keeping it healthy?

Sorry for my slightly delayed response. After going through your history with your daughter’s birth and the current pregnancy details, it does appear that your cervical/vaginal areas are sensitive. It also does appear that your predisposition to cervical shortening could have been caused by the removal of polyps from near the cervix, similar to how a cone biopsy could predispose one to cervical insufficiency. The bleeding earlier on in the pregnancy does happen sometimes – and “mysterious” is the right word – because often there is no cause that you can pinpoint. Sometimes, when you are on hormones, that can become the cause of bleeding, which then quickly resolves itself as the hormonal levels stabilise.

I checked with my colleague, as well as did some extensive searches for any conclusive research on use of ibuprofen in treatment of cervical shortening. No research indicates any particular benefit of this line of treatment. The Cochrane Database, which is one of the most respected bodies of knowledge for evidence-based practice in medicine, does not give much support to this line of treatment as well. So, you might want to ask your OB the reason she is adopting this treatment with you, and could she provide you with some research which validates it?

As regards your faster metabolism, I am sure that this will need to be taken into account every time you are prescribed anything during pregnancy and in the immediate post-natal period. By the way, I was not aware of the advisory regarding the use of Percocet and breast fed babies. Thank you for this information; it will be helpful to my expectant mothers and new moms to know about this.

Especially in your case, it seems prudent to me, not to use any medication unless there is evidence-based proof regarding its effectiveness. Why put you on it, if it is just a trial? You might just as well respond to reduced physical activity. And, when you are put on medication AND bed-rest, if your cervical condition stabilizes how will we know which caused the positive effect – the medicine or the rest? As with any pregnant mom, my sense would be to go with least intervention first.

Finally, as regards cerclage it probably is not the right line of treatment for you. One, as you point out – your system nay not handle it well. But, more importantly, since you are already at week 19, there is an increased risk of uterine irritation and premature labor.

I still think the best line of treatment to follow would be for you to be on reduced physical activity, and to be monitored every 2 weeks. Hopefully, your cervix will stabilize, and you will be able to carry on with the rest of your pregnancy. I am sure you have gone through the posts on this blog, and I realize that each expectant mom is different, but you will find that in a lot many cases, the wait and watch approach seems to work the best.

Hope I have been able to help you somewhat – all the best to you. Do write in if you have any further queries/concerns.

I appreciate your detailed reply. My husband was worried that I am over reacting to the treatment plan by my obgyn and your reply validates my concern. I will talk to my obgyn to modify her treatment plan. I am also glad to know that new moms /new borns in your care who face issues with percocet will be alerted.

Hello Dr vijaya,
In my first pregnancy my cervical length was 2.8 in the 18th week & i was advised moderate bed rest. now in my 2nd pregnancy my cervical length is 2.7 in the 21st week & the doc has advised strict rest ( i am in singapore now) & has also asked me to travel soon if i want to go for delivery in India. Could u pls tell me that is travelling fine in this stage & condition & is 2.7 at this stage ok or something to be really concerned about.
Thanks.

Happy new year to you. I was reading thru the topic and thought to put my concerns over here and if you can guide me.

I am 22wks pregnant. My cervical length is 3.2 cm and doctor told me that my external OS is opened. So my doctor advised me to go for circlage (OS tightnening) to have a safe and risk free delivery. is this okay? This is my first pregnancy though. Is there any issue after circlage? Please advise. Thanks very much in advance for your help and advise.

I am currently 22 weeks and 3 days along in my 5th pregnancy. Prior to this pregnancy, I have had 2 early term (5 week) miscarriages, but have also delivered 2 healthy children! Given that my first child was born at 35 weeks, and that I have had a cone biopsy, I was monitored by a prenatal specialist quite carefully with my second child. With this child, I was put on strict bed rest at 23 weeks due to cervical shortening, but was able to carry the pregnancy until nearly 33 weeks.

With this pregnancy, I have been on strict bed rest since 16 weeks. I am also given weekly progesterone shots. In the past 3 weeks, my cervix has shortened from 29mm to 20mm. At this point, I am going in for weekly ultrasounds. My doctor has told me that we just need to wait and see what happens week to week. I am wondering, however, if you could help me understand if I am doing everything I can? I currently shower daily, get up to go to the bath room, and walk between my bedroom and our family two times a day. Throughout the day, I have also been sitting (at a 45 degreen angle) in a reclining chair (working with a laptop, etc.). But I am worried now, that this position might not be the very best. Would you please let me know your opinion on the reclining (Lazy Boy style chair) and also if I should limit my activity further? I am worried sick and would be glad to stay in bed entirely if this is better for the baby.

Thanks so much for all of your posts. They are such a big help to people in this nerve racking position!

I am 21 weeks now. I have had some contractions since 17 weeks. My ob asked me to scan my cervical length today and the scan result is that mine is 3.2 cm. Do you think I need to take some more rest since it is really near the borderline? And how often should my ob monitor my cervical length?

Hi Dr. Vijaya,
I am 23 preganant with my second child. First baby was delivered only 3 days early with a very good pregnancy. With this pregnancy at 12 weeks I was seen to have a cervix measuring 2.7cm, my doctor gave me a cerclage the next day. I am now 20 w 5 days and so far have had a good pregnancy, still quite active taking care of my 2 year old and doing things around the house. I am on 1 ml of Salbutamol twice daily. I need take a 7 hour flight at 27 weeks and am very worried about the flight. Is there need for concern? My doctor tends toward being fine with everything and that worries me more! Are there risks I should know about? Thank you so much.
Rachel

My cervix was 11mm on my 23 week ultrosound and 12mm the next week. I am given a weekly shot now. I didn’t have any earlier measurments of my cervix so it’s hard to compare how much shorter it is now than before.
I am 34 years old and had 5 early abortions (within 50days) before. This is my first time to carry the baby to the 2 trimister. I had a Batholin’s cyst drained twice 07′-08′.
I know my cervix is rediculously short. But the doctor didn’t put me on bed-rest. He didn’t even mention the bed-rest and I didn’t know I need to until I did some research on the internet. I was still doing excercises for days like running (slowly) and riding on stationary bikes, even after the ultrosound. Now I am all nervous coz’ all the activities are with no doubt on the NO NO list. I put myself on bed-rest now anyway and I am certain it’s a must given my situation.
Do you think my short cervix has anything to do with my previous abortions and the cyst cut?
Today is my first day into the 25th week. I know I have a long way to go and am very worried how long my baby can stay inside me.
I am not sure the name of the injection I am given as I didn’t know it was so serious when my OB called me on the phone. I remember he said it’s for preventing preterm birth so I assum it’s some steriods. I am seeing him in 10 days and there is no further ultrosound monitoring in the future as fas as I know. Do you think I need more intense monitoring?
I am all by myself now coz’ my husband is overseas and my family is not coming until end of January. I am so scared I may come in labor before any of my family could be here!
I am calling my OB tomorrow as I have so many questions now after all my internet research. Do you have any suggestions about what I should ask to my OB?
And what else I could do besides taking the shots and bed-rest?
Thank you so much for being so helpful!

Dr Vijaya
To continue our discussion my wife’s doctor now feels that she should take a drug called nifidefine to quieten her uterus. She is 25 weeks pregnant and has no signs of contractions/pain etc. They recently conducted a FFN test and came back negative. We are wondering if we should accept her doctors suggestion to start taking nifidefine when she has no symptoms of any kind.

Please let us know your thoughts around the use of this drug if you feel its necessary at this stage. Is this drug safe in general. Appreciate all your help and guidance.
Regards
Nick

I am so glad that I came across this website! I would really appreciate your feedback about my situation.

I am currently 23 wks pregnant with twins. At 20.5 weeks I began to feel a lot of pressure and cramping, and went in to labor and delivery. It was determined that my contractions, while at times very strong, were irregular, and so the peri is calling it irritable uterus. I also had a trans-vaginal ultrasound, and unfortunately my cervix was measuring 2.5cm. Since that time, I have been on strict bed rest at home. I have had two more ultrasounds: after one week of bed rest, my cervix was measuring 3.0 cm! But we had another ultrasound a week later, and it had dropped again, to 2.6 cm. Thankfully, there is no funneling at this time. I am still having a lot of irregular contractions, but no more than 4/hour. My perinatologist is calling this “dynamic, incompetent cervix.” He seems very confident that I will make it to at least 28 weeks.

I am trying to stay hopeful, but this is my 4th pregnancy after 3 first trimester miscarriages. This is also an IVF pregnancy. None of my miscarriages were related to cervical incompetence. However, I did have to have D&C’s for my 2nd and 3rd miscarriage. My question is, do you think that the D&C’s might have damaged my cervix in some way?

Additionally, one of the twins has her head pressing right on my cervix. Could this be contributing to extra pressure?

My peri says that there is no evidence that it helps to do a cerclage this late in the pregnancy with twins, and that there would be danger of rupturing the membranes, especially since baby A’s head is right up against the cervix.

Is a cervix that is dynamic, with the length varying back and forth, any different than one which steadily decreases? I am going to a high risk practice, and feel that I am getting good treatment. However, I would greatly appreciate your professional opinion on my situation and its causes.

Since you were able to carry through with your first pregnancy with similar cervical length, I don’t think there will be much issues going through this one either. Having said that, it is still prudent to get yourself monitored every 3 weeks or so. And, strict bed rest is probably better if you are planning to undertake travel in the near future. I would agree that the sooner you travel the better. Not so much because, travel in itself causes any increases in cervical shortening, but because the later you wait, it will become more risky for preterm labor with a shortened cervix.

Once you get to India, after your initial check up, if your cervical length remains around the same 2.7-2.8 range, you can indeed be back on moderate activity levels, and just avoid anything that puts strain on your abdominals.

You are doing everything you can! And no, you don not need to completely restrict yourself to the bed – your activity level seems okay for now.

However, I am not a big fan of the LazyBoy type recliners in pregnancy. First, in case your recliner does not have a manual or an mechanical option to bring it upright, I would recommend that you stop using it altogether. This is because, if you have to get yourself upright from an reclined position, you will land up increasing your intra-abdominal pressure, which is not recommended in cervical shortening. If your recliner can be brought upright, then I would recommend using it no more than 1-2 times a day for short periods of time. The reclining position is the exact opposite of the position that promotes natural childbirth.

I would instead recommend that you try a propped up position on your bed or sofa (provided it is not too low). Another option would be to try the “Butterfly” position which happens to be a great position that promotes natural childbirth – You can have a pillow for back support, a pillow under each knee and then you can use your laptop by placing it on something like a breakfast tray. Let me know if you need more help with this or trying out any other positions within your home.

I do have a question though – with your past history of cervical shortening and preterm deliveries, did your OB discuss with you the possibility of early (13th-16th week) preventative cerclage? This might just be an academic discussion at this point in your case, but you may be able to point out something that might be of help to other moms who are in similar circumstances as you.

At this point, you need not be on any specific precautions. And, your OB checkups can be at the regular monthly intervals. In case, there is more shortening at your next check up, then you can think about reducing physical activities. All research indicates that anything less tan 2.6 cm needs monitoring once every 3 weeks.

I am not sure why your OB did not advise at least a trial of bed rest. Granted, that with your cervix length being so short, so early in your pregnancy, there are chances that even complete bed rest may be only of limited use. However, research shows that there may be some prolongation of pregnancy with bed rest, thus allowing you to carry your baby closer towards your due date.

Did you need to have a D&C done for your previous miscarriages? Although the early miscarriages in itself do not predispose you to having a short cervix, multiple D&Cs, as well as the cyst drainage could be predisposing factors.

Finally, you should be monitored every week by your OB – I am really not sure why this is not being done. You can probably bring this up to him when you see him for your next visit.

I would recommend that you continue with your bed rest. You can get up for bathroom and shower activities, some walking around your house is okay too. Do not have prolonged periods of sitting/ standing. Do not lift anything heavy and also avoid constipation/straining at stools.
Hope this helps –

Nifedipine is primarily used to decrease chances of preterm labor, and primarily in expectant moms with hypertension. Though it is generally a safe drug, it does increase maternal Heart rate, and can cause decrease in blood pressure. This can become more in case of moms who have normal blood pressure, and can lead to dizziness and sweaty palms. It is also known that Nifedipine causes the baby’s heart to beat faster as well.

With your wife not showing any signs of contractions at this stage, it would make sense to wait and monitor on a weekly basis rather than start off with Nifedipine right away. Also, there is no research pointing to the efficacy of use of Nifedipine with regards to cervical shortening. Having said that, in case preterm contractions occur, then it would be worth while to start her on any of the tocolytics to prevent going into preterm labor.

Your length of cervix varying between 2.5-3.0 cm, is actually borderline. Were you not carrying twins, and not experiencing the contractions, I would have recommended that you be on regular activity levels, and just be monitored by your OB. However, since you are experiencing uterine irritability, as well as one of the twins’ head being directly on your cervix, bed rest would definitely be the way to go.

As regards your previous D&C’s, it may have predisposed you to this – but we cannot be sure.

Your OB is right, doing a cerclage this late in your pregnancy has more risks than benefits.

Finally, your cervix can sometimes show those variable lengths. Since the measurements are highly dependent on the skill level of the person who does it, whether your bladder is empty of full, and how your baby is positioned sometimes the readings can get slightly different. I would definitely recommend that you go for your ultrasounds with as full a bladder as possible, because, this tends to push the cervix into a greater position of visibility, and can thus get you more accurate measurements.

As long as your cervix is fluctuating within this borderline range, you do not have to do anything more than following your bed rest precautions.

Once you reach your 28th week, then you can take each week as it goes. Who knows, you may carry the babies to term! Positive thinking, fingers crossed :)

Thank you for your information regarding the use of the reclining chair. I have taken your advice, and cut the use of this chair almost completely out. Despite my very strict bed rest, since I last wrote, my cervix (week by week) crept down to 1.75. Just yesterday at my weekly ultrasound appointment, however, I measured 2.2. This was really encouraging news!

Throughout the pregnancy, I have asked my physician about doing a cerclage. Although it sounds as if this is a fairly common procedure with their clinic, in my case, they consistently wanted to “wait” another week before determining if I needed the surgery. Soon, I found myself at the outer end of the option. At 23 weeks, (when my cervix reached 2.0), they seemed to leave the matter in my hands, saying that they could do the surgery that day, if I wanted. Given the risks involved with surgery, and the possibility of further irritating my cervix, my husband and I opted to not go forward with the cerclage.

I’m not sure if this was the right choice, but at this point, I can only hope that it was! :)

Thanks again for your thoughtful advice… It has been a great deal of help to both me and my family!

Thank you so much for your reply! I just wanted to update you on my situation. I am now at 25 weeks, and at my TVU yesterday, my cervix was down to 2.0 cm. Thankfully, there is still no funneling. I am continuing with the strict bed rest, and hoping that I will make it to 28 weeks.

A quick question: I had an FFN test this week, and it came back negative. The doctor said I should find this reassuring. However, it is my understanding that cervical insufficiency does not necessarily go hand in hand with pre-term labor. In other words, couldn’t my cervix shorten, soften and dilate without my having symptoms of pre-term labor? I would appreciate your thoughts on this!

My wife is currently at 25w6d of her pregnancy with twins. It is her first pregnancy.

At 23w1d she had a routine check with her perinatologist and it was discovered that her cervix was over 4cm, but funneling down to 1.5cm. So, the perinatologist suggested cerclage or observation for a few days in the hospital. I was out of town, so my wife chose to stay at the hospital for observation until she could find out more about the cerclage, where she was hooked up to a toco-meter to check for contractions. She didn’t seem to be having regular contractions (only occasionally ~4 per day), but the activity on the monitor indicated what the doctors called an “irritable cervix”. The perinotologist put her on a 72 hours course of indocin (2 pills per day, not sure about the dose). She immediately got clogged sinuses and would see blood whenever she blew her nose. This cleared up as soon as she stopped indocin.

After talking to 6 different doctors about the cerclage where only 1 thought it was needed, she declined the cerclage at 23w4d.

After a week in the hospital her cervix was again checked via ultrasound, and this time it was 4.5cm, but funneling down to 0.8cm. The perinatologist decided to keep her in the hospital until delivery on strict bed-rest. Again the perinatologist suggested indocin, but she declined given the previous side-effects.

Four days later with increasing mini contractions the perinatologist suggested a shot of terbutaline. That immediately calmed down the contractions (but made her very jittery and her heart race) and produced a nearly flat curve for 24 hours before a few small contractions happened again the following evening.

Taking liquid calcium magnesium, cramp bark, magnesia phosphorica pellets, and doing relaxation meditation, she seemed to be able to calm her contractions over the following 2 days (just a few each evening). Still we are concerned they might start again and would appreciate any advice you have.

In particular we are very concerned about the terbutaline and especially having her on the terbutaline pump for a longer period due to the potential side-effects on the babies such as autism and more.

We have heard about some alternatives to terbutaline which might have fewer side-effects:

We asked the perinatologist about these or other alternatives. The perinatologist did know about nifedipine, but suggested terbutaline for now due to my wife’s low blood pressure. The perinatologist didn’t know of atosiban and magnesium phosphorica via injection, or any other options with fewer side-effects than traditional tocolytic drugs like terbutaline, magnesium sulfate, and indocin.

What are your thoughts on the risks and side-effects of terbutaline and other conventional tocolytic drugs, and do you have any advice about alternative methods to calm the uterine muscles?

Do you know of magnesia phosphorica injections or cramp bark and how effective they are?

We really appreciate your answers on the blog which has been a very helpful source of information.

I was just reading your article and replies to queries and was really impressed by your quick, personal and so very informative replies. Hope you can help me.

I am not sure if I fall into the low cervical length category.

I ve had an elective abortion(with D&C) 6 years ago and had a first trimester miscarriage last year. I am currently in my 25th week of pregnancy, starting 26th week tomorrow. I went to my gynaec complaining of gas like cramps and some discharge that I thought was thicker than usual. She got me admitted for observation, as at the time my cervix was soft and the external os allowed the tip of the finger in. The ultrasound showed a cervical length of 34mm. (It was 36 mm at 19 weeks)

She’s put me on duvadilan and progesterone along with drugs to stop gas pains, and asked me to get the cervical length checked after a week and follow up.

What should be done? Is her course of action correct? I ve been put on reduced physical activity and a modified bed rest.

Glad to note that your cervix is beginning to show some signs of stability .. it is very possible that this could start varying again, but for now – chin up and cheers :)

Thanks also writing in about your options regarding cerclage and why it was not done – it will be good information for other moms in similar situations. Finally, at 23 weeks your choice of not opting for the cerclage was probably the right one.

To answer your question, yes, you can have cervical dilation without symptoms of preterm contractions. However, the FFN is a very sensitive test, and has a negative predictive value of as high as 99.7%. In plain language, this means that if you have a negative FFN test, your chances of going into labor within one week of the test, is as low as 1 in 333. So, I think your doctor is right that you should find your test results reassuring! :)

Today 03.02.2008, my wife was scanned on her 21 wks 6 days maturity. Results shown “Internal OS is closed. Cervix measures 2.6 cm in length. Cervix is short. There is no funneling of cervical canal at present.” Doctor, Is she is at risk part? Our Gyn prefers a Cervical Stitch and a strict bed rest. Doctor, do you have any recommendations? What shall we do sir. Please advice. Thanks. Sha

1. Nifedipine would probably have been a better choice, all things considered. However, due to your wife’s blood pressure being on the lower side, as you point out, it may not work.

2. Terbutaline – side effects are greater. Maternal heart rate will have to be monitored, and be kept between 90-105 bpm. If used, it should be continued until 35-37 weeks, when it can be slowly tapered off. However, a large analysis of literature, and studies has failed to find and significant benefit of oral maintenence therapy on this drug alone.

3. Atosiban – Not enough research yet. One study: 513 women were tested on Atosiban versus Placebo. There was no difference in the ability to inhibit preterm birth. The authors concluded that there is insufficient evidence for use of this medicine at present. In any case, it is NOT FDA approved yet.

4. Magnesium – In any form, (liquid, with calcium, or as Magnesium sulphate), there is not enough evidence for its beneficial use to prevent pre-term labor. A study of 2000 women reported by Cochrane Collaboration found that infant mortality and serious health problems in the case of mothers who had taken Magnesium Sulphate to prevent preterm labor, to be much higher.

5. Indocin – I am glad that your wife stopped taking Indocin. Many studies report that taking of this drug is associated with decrease in amniotic fluid levels, fetal side effects, as well as twice as much neonatal illness.

6 – I have not found any research and do not have any evidence-based experience of mothers benefiting from taking cramp bark and magnesium phosphorica pellets or injections.

In conclusion, I would still recommend that your wife try modified bed rest and relaxation techniques at this time and if need be, be on minimal dosage of Terbutaline if her uterine contractions increase.

I forgot to mention one more thing in my last post to you. Most good hospitals and teaching institutions will use strict criteria to qualify “preterm labor”. One such criteria is the “Creasy and Herron Criteria” of preterm labor. This is used between 20 weeks – 36 weeks+6days of gestation. Only if uterine contractions are 4 per 20 minutes or 8 per 60 minutes and accompanied by premature rupture of membranes (bag of waters), or cervical dilation greater 2 cm, or effacement (thinning of cervix) greater than 50% or changes in dilation and effacement detected by serial cervical exams is it qualified as preterm labor.

Otherwise, it is just uterine irritability and should be treated with as minimal intervention as possible. Anyway, almost all interventions including medications and/or bed rest have only empirical evidence for use, and in the end, work differently in each expectant mother.

2.6 cm cervical length is borderline normal. Research indicates that just monitoring every 3 weeks or so should be sufficient at this point of time. Even bed rest is not really required. However, your wife should avoid any activities such as lifting that can increase intra-abdominal pressure.

In terms of cerclage (stitch), as your wife is past her 21st week, there is an increased chance of uterine irritation and preterm labor. You will have to take this into account if you decide to go in for it.

Hope this helps .. feel free to write in if you have any other queries.

Dear Dr. Vijaya,
My question is actually about cervix dilation, hope you allow me to ask it here.
Once the cervix is dilated, say, to 1cm, at week 27 or 28, if doing bed rest and maybe do kegel exercise. Would the cervix every close again or it would just stay dilated till after birth? And once the cervix is dilated, can it still be stiched or not?
Thanks a lot!
Jane

Hi Dr Vijaya,
Hello, I have just been reading through previous posts and have found all of your advice/info. to be the most helpful I have come accross thus far (and I have done A LOT of research). I wanted to give a bit of background before I ask questions. I had a previous full-term delivery with my daughter who is now 9. I did have a VERY irritable uterus, contracting all day every day about 10 times per hour for the last 10 weeks of pregnancy. Don’t know that this was truly pre-term labor though, and was on terb for many weeks. Ultimately I had to be induced. Shortly after this birth I had a LEEP performed.

Fast forward 7 years and I became pregnant with twins. Going in to this pregnancy, I was told that I would be watched a bit more closely due to the LEEP but that there was not too much concern. I started with the intense uterine irritability very early this time (about 14 weeks) and at 17 weeks was found to have a cevical length of 1.7 with significant funneling. I was on very strict bedrest from that point on and my cervix continued to fluctuate slightly but remained very short. I think the peri called it “dynamic.” I was also on procardia, terb, and indocin at various times throughout the pregnancy. At exactly 29 weeks my water broke. I was put on antibiotics. 3 days later I ddeveloped high fever and was rushed into delivery. My daughter survived, my son did not. He was born septic and died 8 hours post-birth. It was heartbreaking to say the very least. My daughter is now a healthy happy very normal 18 month old.

SO, currently, I am 23 weeks pregnant. This pregnancy was a tricky thing to deal with since no one was really sure if I truly had an incompetent cervix last time due to the LEEP or if the shortening was just a result of twins. I opted, and my peri agreed to do a cerclage at 14 weeks. He did tell me at the time that my cervical length was on the short side, about 3cm. Since the cerclage I have done well and have been monitored every other week. My cervix has remained between 3.3cm and 4.2cm, with the last measurement being at 22 weeks. I, however, am absolutely terrified given all that occured with the twins. I am also on the p17 shots weekly. I have started to have some uteine irritability which seems to be par for the course for me. So here are my questions for you . . .
1. Would you suggest being very proactive with my uterine irritability given that my water broke early last time? My instinct is to take every drug that I can for this to just make it stop since it scares me, but my doc is somewhat conservative about giving meds. He did give me a script for procardia but gave me strict guidelines as to when I should take it (like a certain number of contractions per hour). Do you think that terb is more effective than procardia? What about the terbutiline pump?
2. Do you think that my water breaking last time was caused by my cervix being so short? Can these two things be related? I know that I did not have a UTI at the time. Or can uterine irritability itself cause the water to break?
3.In your experience, does having a LEEP typically lead to incompetence? I do know that its a risk factor but I have never actually heard of anyone else developing cervical incompetence because of it. Clearly, my hope is that my problems were more “twin” related, than “cervix” related.
4. Would you suggest modified activity for me at this point?

I apologize for the length of my post and appreciate you time. Thank you,

I am not aware of anything that would make the cervix close again, once it starts to dilate. Mothers on strict bad rest have been seen to occasionally be able to halt funneling and drastic shortening of cervical lengths. However, whether this was in response to just decreased physical activity or whether this was just the way their body was acting, we cannot be sure. Bottom line is that we try everything possible in the hope that our moms can hold on to their pregnancies for as long as possible without going into preterm labor.

As regards the placement of a stitch, at week 27-28, there are more risks than advantages. I would not recommend this as an option in your case. Another thing is, you have not mentioned what the length of your cervix is; based upon this you can determine levels of activity that are appropriate for you. The writing at the top of these comments, should give you evidence-based guidelines regarding your possible activity levels for the rest of your pregnancy.

As regards this pregnancy, I think you and your OB have probably done the right thing in going in for a cerclage. With your previous history, I think that this gives you the best chance for carrying your pregnancy for as long as possible. And, your cervical length seems to be very reassuring.

I also think that taking medicines should be only on an as need basis. I understand your worries based upon your past experiences; However, every medicine crosses over the placenta, and every medicine has some side-effects (both for you and baby) – some well-documented, others not. So, it would make sense to use only when needed, and as minimal as possible. Procardia seems to be the right choice for you at this time – especially if your blood pressure normal. If you tend to have B.P that is on the lower side, it can cause extreme low blood pressure, and you would have to be monitored very closely. Terbutaline is known to have more side effects (and more incidence of newborn illnesses) than Procardia, so I would go with Procardia if it works for you. From what you have told me, I would not recommend Terbutaline pump at this point yet.

As regards your query regarding the cause and effect of LEEP procedure on cervical length, research has found that there is some amount of increased tendency to shorter cervical lengths in pregnancy in mothers who have had this procedure done previously. However, in your case, as you point out, we will never know for sure whether it was that alone, or the pressure of the twins on your vulnerable cervix, along with your irritable uterus, which caused your bag of waters to break. It could have been one or the other, or both. However, we do know that Indocin has documented remarkable adverse effects – one of them being decrease in fluid levels. If this had happened, it may have further triggered more uterine irritation, which could have led to your bag of waters breaking. Again, this is only conjecture based upon what you have told me; I would like to know what was the rationale behind putting you on Indocin at that time, and what your OB thought about the early break of your bag of waters. This information would be good for other moms in a similar situation.

Finally, with having had a cerclage done, and with your cervical lengths being very decent at this point, I would not worry too much about being on modified bed rest. Definitely, do avoid lifting anything heavy, and anything that can cause an increase in intraabdominal pressure as well as sexual intercourse. The uterus is a muscle – and like any other muscle, it responds to active relaxation techniques. I have also had some wonderful results with moms doing relaxation therapy, meditation, music and breathing exercises. Granted, these do not take away the cause of the uterine irritability – but they do tend to decrease the rate of uterine contractions, which is what you want!

Hope this helps – please feel free to write in if you have any other queries.

First, I just want to take a moment to express my thanks to you and to let you know how much I appreciate your thoughtful and detailed response to my post (and all of the other posts). When experiencing a high risk pregnancy it is so nerve-wracking and also so easy to begin to feel alone and unheard. This site and your caring and honest responses and information is so amazingly helpful and, unfortunately, hard to come by. So, again, thank you.

I am glad to hear that you agree with my doctor’s course of action at this point. It is comforting to have a second opinion on the matter.

In terms of the indocin given during my last pregnancy. To be honest I don’t know what the rationale was behind it. It was actually the first drug that was offered to me and I didn’t ask many questions. I was told about the risk of it affecting my fluid levels and I believe that my fluid was observed during my ultrasounds, which were done often. I will add that I have switched doctor’s for this current pregnancy and he will not give indocin for the reasons you stated. As far as my water breaking . . .it has remained a very frustrating and unnerving unanswered question. My current doctor has made the guess that perhaps it was linked to my very short cervix. At the time that it occured it just seemed very out of the blue. As I said, I did end up spiking a fever and developing an infection after three days of being ruptured (and this was in spite of all the I.V. antibiotics I had been getting.) My son died specifically of a septic e-coli infection which he was born with. So, no one was really certain what the hec happened. Of course, it was a question of; did infection cause me to rupture or did rupture allow for infection? No one was ever able to answer this and to this day I really have no idea what happened. I think that my doctors were as dumbfounded as we were. The unanswered questions surrounding all of it have made for a very difficult pregnancy experience this time. The obvious question I have had is; if we don’t know what happened last time, how can we prevent it from happening again? Not having answers is hard.

I did want to ask you, want to you mean when you say intra-abdominal pressure? I do have an 18 month old that I’m constantly hauling around. Would you suggest I stop doing this, or limit as much as possible? Also, you mentioned meditation and relaxation. Would you suggest certain CD’s to guide in this. I have never tried any of that.

Thank you for your kind words. I strongly believe that every expectant mom should feel well supported during her pregnancy; it just becomes doubly important for people with high-risk scenarios.

Also, thank you for your detailed response regarding the Indocin line of treatment in your last pregnancy; the information will help other moms and their families.

As regards music and meditation, any music that relaxes you will help; what I have found is that any music with repetitive soft notes helps with relaxation. Do take out time for yourself, and practice deep breathing techniques during that time.

As far as intra-abdominal pressure is concerned, I do think you should limit carrying your 18 month old. Other things that increase intra-abdominal pressure are straining at stools and coming up to sit from lying on your back, or raising yourself up from a recliner. You can try and limit these things as much as possible.

My wife is 13th week pregnant and she had the cervix length of 2.5cm and our doctor advised her with cerclage in 5th month. She had the history of mis-carriage in late 3rd month in her first pregnancy. we are bit worried for this issue. Kindly advise us about precautions to be taken to have a safe pregnancy this time.

As per current research, 2.5 cm cervix length is at borderline lower end. If your wife did not have other risk factor, I would not have recommended anything except a wait and watch approach.

However, with her history of previous late 3rd month miscarriage, it may be worthwhile opting for the cerclage. Typically, for first trimester miscarriages preventative cerclages are not recommended. In your wife’s case though, late 3rd month miscarriage almost blends into the 2nd trimester. Hence, as with any unexplained previous 2nd/3rd trimester losses, it might be better to opt for a cerclage.

Having said that, I am not sure it is a good idea to wait until the 5th month. If your doctor wants to do a cerclage, the ideal time would be between the 13th -16th week. Once you reach the 5th month, there are definitely more chances of uterine irritation caused during and post-procedure, due to the pressure of the growing uterus on a shortened cervix. If this happens, it has the possibility of triggering preterm labor.

I would definitely recommend that you bring up this issue with your wife’s OB and find out why he/she is wanting to wait until the 5th month to do the cerclage. All current research recommendations indicate that doing preventative cerclage is better between the 13th-16th week; sometimes even as early as the 11th week.

Hope this helps .. please feel free to write in if you have any more questions or concerns.

I am almost 17 weeks pregnant at 15 weeks my cervix measured 3.0 cm and went to the dr. the following week, at 16 and my cervix measured 2,5 cm no funneling or dilation. I had a LEEP when I was 27 and I am now 33 and had a baby at 36 weeks because of PPROM with no contractions or any signs. With my first pregnancy at 21 weeks I was3.3 cm measure by a non-vaginal u/s.

The Dr, did not put me into any kind of rest or anything, I am supposed to be back to measure cervix in a week. If they see any shortening they will assess again. Please let me know, what would be your recommendation. It is possible for the cervix to increase in measure by itself?

Hello! I am in my first pregnancy. I had a LEEP procedure done about 5 years ago so my OB wanted to watch my cervix during my pregnancy. At 19 weeks I measured 36-37 mm and at 24 weeks I measured 31 mm. My doctor has suggested that I take it easy by limiting physical activity, not lifting anything, and avoiding any “bearing down” actions. She also suggested we use a condom if we are still having intercourse. I go back for another US at 27 weeks. How concerned should I be? How much should I be cutting back on activities? I tend to be fairly active and it is difficult for me to sit around while my husband does everything for me. Of course I realize that ending up on bed rest would be far worse. I appreciate any input or advice you can share with me.

With your cervix measuring at 2.5 cm, you are borderline short. I think you need not take any particular precaution such as reduced activity at this time. However, I would recommend that you avoid lifting weights, and avoid constipation and straining at stools. If your cervix continues to show shortening at your next OB visit, modified bed rest may be required to stabilize the cervix. Although we do not necessarily understand the mechanism, many moms have stabilized cervical lengths and/or slight increases with modified bed rest.

Your PPROM at 36 weeks in your last pregnancy, may not be necessarily related to cervical shortening. So, at his point we should not be overly concerned about that – rather, we should base our next course of action dependent on the current situation as per your OB checkup.

You are doing all you can .. I am glad that your OB is not too conservative. She is adopting the right course of action for now .. that being wait and watch. Limiting the activities that she has told you is perhaps all that will be needed. Other than that, you can be reasonably mobile, as long as you are not increasing the internal pressure in your abdomen (as would happen with straining at stools, or getting upright from a low recliner, etc).

In case your cervix shows further shortening at your next check up, you can then follow modified bed rest. Hopefully, you won’t get to that .. we’ll keep our fingers crossed! :)

Do write in after your next check up, or if you have any further queries ..
Dr. Vijaya

Hello Dr. Vijaya,
I wrote to you just a couple of weeks back so I won’t go over my history again. Just had a couple quick questions. I am currently 25 weeks 4 days pregnant. I made my first trip to labor and delivery 2 days ago because my irritable uterus was acting up. I was having contractions, although irregular, so they gave me a shot of terb and that calmed things down. At the hospital my doc came and measured my cervix and it was 3.3. My bladder was empty, which he didn’t want but timing didn’t work out. So, the next day I followed up in his office and my cervix measured 4.1. This was with a full bladder. So my question for you is…which of these measurements is the true length? From what i understand, it is unlikely that my cervix grew overnight. Does having a full bladder add length and therefore give a false reading? I should add that my ultrasounds are always done over the abdomen and not transvaginally. I assume that this is because of the cerclage.
My other question is just about the contractions and irritability. I was sent home from the hospital on 10mg of procardia every four hours. Even taking this, however, I contract. i asked my doc about tebutaline and he didn’t want to give it to me. He said that there was more we could do with the procardia first and he wanted to give that a chance at this point. do you feel like this line of treatment is appropriate? Keep in mind my uterus is incredibly obnoxious and just likes to contract all the time. I decided to just go with what my doc is suggesting, although I could become more pushy if need be. I do feel like terb works better than procardia, however, the side effects are also much worse which is most likely the reason for my doc’s hesitation. I will be checked every two weeks at this point. Thanks for your time and input!

I am glad that your cervical length is very reassuring at this point. To answer your first question, the measurement with the full bladder would be the more accurate measurement. We always recommend moms to go in for scans with full bladder, for the simple reason that a full bladder pushes up the cervix into better visibility, and gets the best measurement of length possible through an abdominal ultrasound. Of course, a transvaginal measurement would be the most accurate, but is not always possible, such as in your case. In fact, sometimes a transvaginal measurement triggers minor uterine contractions as well, and its risks have to be weighed against the benefits.

Regarding your second question: I would again be inclined to second your OB’s line of treatment and give the Procardia a chance. It would be equally easy to change to terbutaline, but knowing the increased incidence of maternal and fetal/newborn adverse effects, I think following the Procardia line of treatment would be the safer alternative, unless you feel it is having zero efficacy in managing your uterine irritability. By the way, how many contractions are you having in a hour and over a whole day?

Apart from this, I would like to suggest one more thing – a hot bath/shower can do wonders to calm an irritable uterus. Even though its effects may last only for a hour or two, I would think it would be worth your while using this as a physical relaxation measure, whenever you find that your uterus is contracting more than what it does usually. We use this very often with our laboring moms, when they have irritable uterine contractions that are not allowing true labor to progress. The effects that I get with something as simple as having the laboring mom sit on a chair and have her support person pour warm water over her belly for 10 minutes are remarkable. The irritability eases, and suddenly the contractions change to more rhythmic and meaningful contractions, and this lets her labor progress naturally. Granted that in your case, we are addressing a much different issue. However, since the physical part of the uterine contractions and irritablity remain the same, it might be well worth a try as your go forward in this pregnancy.

Wish you all the very best .. do write in if you havge any more questions
Dr. Vijaya

Hi Dr vijaya,
thank you for your response and suggestions. Just to answer your question. According to the home monitoring machine I have been using, I usually have about 3 maybe four contractions in an hour. But I have irritability and/or tightening many times an hour throughout the day. Some hours are better than others. I have been monitored and have been told to mark the tightening that I feel. More often than not, it is not considered true contractions, although I still worry and find it to be really annoying though not painful. I did expeience this with both my previous pregnancies. With my singleton (pre-leep) this cause no cervix changes and i went to 37 weeks and even needed help to progress my labor. With my twins (post leep) this may have caused cervix changes. The cervix most definitely shortened, but whether it was a twins thing, a leep thing, a contraction thing, or all three is unknown. So, obviously I worry this time because I just have no idea if all the tightening/irritability will set off changes to my cervix at some point. Ugh. It’s very frustrating. i will try your suggestion re: the warm shower. Thank you.
heather

Dr. Vijaya,
Almost 18 months ago I gave birth to a completely healthy full term baby boy after having a completely healthy “textbook” pregnancy. I am now 24 weeks pregnant with my second child and have had nothing but trouble. I was diagnosed with Hyperemesis at 8 weeks and am still on Zofran to control it (though I have cut back to once a day.) At my 20 week scan it was discovered that my cervix was measuring 2.9 cm. (I have never had any cervical trauma or procedures done prior to this pregnancy…and was not diagnosed with having a short cervix with my first.) The doctor was baffled at my situation. Two weeks later I was remeasured at 2.6 cm and 2.5cm with pressure on my abdomen. My high risk doctor decided to have me come back the following week for a fFN test and another trans-vaginal ultrasound to remeasure. (In the meantime I was told to lie down as much as possible, but was not given any strict bed rest instructions. He also put me on 10mg of Procardia every 6 hours for the few inconsistent contractions I was having.) My fFN came back negative, which was a relief to me, but my cervix was measuring 2.3cm and 2.1cm with pressure applied to my abdomen. I was still having some contractions, mainly if I had been vomiting, and pretty consistent menstrual type cramping. He has me taking 200mg of Progesterone by vaginal suppository nightly. I go back in a week for another fFN and cervical measurement. I am still getting what I feel are Braxton Hicks ; is that normal? Last night I had one contraction, followed by another 10 minutes later that woke me from my sleep. Is this normal? Should my meds be altered? What are your thoughts? I am terrified as this is unchartered territory for me. I am a stay at home mom to my almost 18 month old son (and live in a two story home) and would like to know if there are precautions I should be taking. Thank you, Erin

hello Dr Vijaya
i loved all your replies and found them very useful.
my question is, i am 29 weeks today have a cervical lenght of 2cm and funneling measuring 3.4 in length. i had a rescue cerclage at 21 weeks with no infections. was on bed rest but had to go on strict bed rest at 26 weeks when funneling increased to 3.4. i am only allowed to use the toilet but told but have been having bed baths and using a bedpan to wee. do you think this is too severe and i should be alowed full bathroom priviledges.
also at 26 weeks they satrted me on progesterone shots every week and take ventolin tablets twice a day to prevent contractions although i dont think i have contractions i ony told my doc that i was feeling pressure down there. but it is better now. i am puzzled at the fact that when i went on strict bed rest the funnelin was 3.2 but when i had a scan 3 days ago it had increased to 3.5. pls can u explain
my main question is that i would be travelin on a 6 hour flight at 31 weeks i only came on holiday to my native country and found myself in this predicament…is it safe to travel? and do i go straight to my hospital upon arrival. thank you

Sorry it took me a couple of days to reply. Several of my expectant mothers went into labor, almost in tandem; and it took a few days for things to settle down!

To answer your questions:

!. With your cervical measurements the way they are, I think limiting physical activity should be good enough. I do not think strict bed rest is warranted at the moment (which is good news for you since you have a 18 month old!)

2. Do not lift anything heavy; avoid lifting and carrying your older one; avoid straining at stools; avoid sexual intercourse; avoid coming up to sit from a lying on your back or reclining position – instead roll over to your side and use the support of your hands to get yourself up; avoid sitting on very low surfaces. As regards using the stairs, I would limit it to the extent possible – at this point you do not need to worry about completely avoiding it.

3. Ffn being negative is good news .. however, I am not sure what has triggered your uterine contractions. In any case, it looks like your high risk specialist is following appropriate lines of treatment. I would just check with him regarding two things:
– Is a transvaginal ultrasound absolutely required? Sometimes internal ultrasounds can trigger further uterine irritability. Since your cervical length is just borderline short, you may still be able make do with abdominal ultrasounds (with a full bladder) and a repeat Ffn to just be on the safe side.
– Why has he put you on Progesterone through vaginal suppository? Sometimes, this can trigger irritability as well. I am assuming he has done this because of your hyperemesis?? If this is not the case oral or even progesterone shots may be an option to look into.

Over and above all of this, I would encourage you to go through my replies (a few entries above yours) to Heather. Do try music, meditation, relaxation, breathing and warm showers with warm water running over your belly – all wonderful (albeit temporary) techniques that are useful to reduce uterine irritability from time to time. When you cannot alter the cause, you can at least try to minimize the effects.

Also, something you can try in order to reduce your nausea/hyperemesis – try chewing on a whole clove. (Clove is spice that should be readily available; if not you can try Indian grocery stores- they will most definitely have it). Clove has anesthetic properties; it numbs the oesophagus, and reduces nausea. May be worth a try as you are trying to cut down on Zofran.

The ultra strict bed rest regime is because of your funneling. The length of the cervix, though definitely short is not alarming in itself; however, put together with the increased funneling, it is better to take all precautions.

Having said that, he complete bed rest does not seem to have arrested/reversed your funneling. This could be due to differences in the way of measuring, your fullness of bladder at time of measurement , or simply something that we do not understand or know. Bottomline – do continue strict bed rest for a while. However, you should be able to have full bath room privileges, provided someone is there to help you in case of need. 10-12 weeks is a long time to go without being able to use the restroom, and without having a shower! Obviously, I would recommend keeping the bathroom trips as short as possible. You can even have someone help you with pouring water over your body as you sit on a chair and finish bathing.

As regards your travel – ideal would have been not to travel. But, since it is unavoidable in your case, do take your tocolytic (medicine to decrease uterine contractions) before you travel. Also, it is ok to take the steroid shots to mature your baby’s lungs; but take them only just prior to travel . They are usually administered as two shots over a period of 24 hours. Research has found that the effect of the shots lasts only for 2-7 days, and that repeat shots are not that effective. So, in order to give your baby the best chance in case you have premature labor as a result of the travel, you should have one shot 48 hours prior to your travel date; and the second shot 24 hours prior to your travel date.

Finally, unless you are felling uncomfortable at the end of your journey, or feeling pressure downwards in your vaginal area, or experiencing periodic tightening/ contractions during or immediately after your journey, you need not rush to the hospital immediately. However, it would be recommended that you go to the hospital as early as possible after your trip in order to get checked. In case you have any of the symptoms that I mentioned above, you should straight get yourself to the hospital from the airport.

Dr vijaya
thanks alot , yu have put mind at rest and i just wanted to say that i was allowed to shower and use the rest roo for the first five weeks until the funneling got worse, i hav been having bed baths since. your comment about not using the restroom made me sile and i said to myself i better correct this impression.
thanks this site has been most informative

Dr Vijaya- after referring to my books and many many online resources, i found your article and comments the most useful. thank you very much.

my doc told me i have cervix shortening at my 31st week scan 10 days ago, and measured it as 3.3cm. he told me to reduce physical activity. would you give some more advice on what this means? does that mean i should avoid going on walks, or attending swimming classes for pregnant women? what about intercourse? he has not given me bed rest or any instructions to follow about reducing my activity level, so i am not sure what’s the right thing to do. i want to be more active so i’m prepared for the birth, but i wouldn’t want to do anything that puts my baby at risk.

Thank you for the response Dr. Vijaya. My second fFN came back negative as well…so I am feeling good. After being put on bed rest after I wrote you (only up to eat and use the restroom) my cervix held steady at 2.1cm. I am not sure why my doctor put my on vaginal Progesterone. I will definitely be asking him about that at my next appointment on the 19th. I would prefer a different form of it since my insurance does not cover the suppository. Thank you for all of the advice. I appreciate it greatly! It’s always nice to get several professional opinions. You are doing a very kind and selfless thing by helping all of us anxious mothers!

Dr. Vijaya, I am 19 weeks and 1 day and at my appt yesterday my dr saw that i had some funneling from inside and my cervix is still 3.2 cm. I had a cerclage during 14 weeks. Should I be concerned about the funneling. My previous pregnancy I lost my son at 20 weeks and 5 days.

I just wanted to give you the latest update. I had my follow up ultrasound today with the same doctor who checked my cervix approximately 8 weeks ago. 8 weeks ago it measured 36-37 mm. 3 weeks ago it measured 30-31 mm. Today it measured 32-33. Good news! The reduced activities seemed to do the trick. For now the perinatologist said to continue doing what I have been and he doesn’t even think a follow-up check is necessary. I will talk to my OB about it at my appointment next week. As Erin said above, thank you so much for being such wonderful help to all of us. You helped put my mind at ease.

Dr Vijaya
i would also like to update you on my progress.
bed rest does help i had a scan done 2days ago on monday and the funneling has reduced and my cervical lenght is almost 4cm so i think i will continue with the programme till i fly out next week.
thanks for all the advice

Hi Dr. Vijaya,
I’m back. :) I hope that you dont mind me asking frequent questions. I like the second opinion. So, at my last cervical length check, at 27 weeks, 3 days, my cervix actually measured 5.0, which astonished me! I’ve never had that type of length before! So, I am obviously very happy about that as is my doc. The thing that I wanted to run by you is this; I went in to the appt. prepared to really try to convince my doctor to either increase my procardia dose or perscribe terb for my contractions, which are now pretty constant and uncomfortable and scary! But, after seeing my cervix length he wouldn’t go for it at all. He said that unless he sees a trend toward cervical shortening he won’t give meds. What do you think about this? I mean, isn’t there a point at which you want to control the contractions regardless of their effect? Do you believe that if the cervix remains stable it is fine to have contractions constantly? Do some people just contract until the end but never dialate?? I am just so worried that cervical change will occur and I wont know it! Thanks for your advice,
Heather

Thanks for the update .. even though we do not know how bed rest helps in improving or stabilizing cervical lengths, research based evidence seems to suggest that it does help most mothers. I am glad that it has helped in your case too. Thank you for sharing your experiences; it will help other moms who are in similar situations as you.

Good luck with your flight – as always, please feel free to write in ..

I wrote to you a couple of months ago and your suggestions and encouragement were very helpful! I just wanted to give you an update on my situation. I have been on bed rest at home for 10 weeks, only getting up to use the bathroom. I went on bedrest at 21 weeks due to a shortening cervix (it was 2.5cm at the time and very irritable uterus), and because I am pregnant with twins and Baby A’s head was pressing down very low on my cervix. I do not have a cerclage.

I am now at 31 weeks, and my cervix has gradually shortened to 1.7cm. It is fingertip dilated, and my perinatologist says it is extremely soft. Both babies are head down, and are exerting tremendous pressure on my pelvis. Thankfully, my FFN test this week came back negative. I will continue on bed rest at home for the remainder of the pregnancy.

Here is my question: at this point, my perinatologist feels that it is no longer useful to continue having regular transvaginal ultrasounds to measure cervical length. He says it is harder and harder to get an accurate measurement, and that now that I am past 30 weeks and carrying twins, my cervix will naturally be shortening quite a bit. He feels that he can get a better sense of what is happening (whether there is effacement and/or dilation) through manual/digital examinations. Do you agree? Is there a point at which precise cervical length measurement is no longer so important?

Thank you so much for taking the time to read this message. I really appreciate it!

Glad to have you back – Would have wondered how you were doing if you did not post an update!

Great news – cervix length of 5.0 – you astonished me as well :)

To answer your question –

1. Your cervix length is showing no reason for alarm whatsoever.
2. You have a cerclage in place.
3. You have had irritable uterus all the way through, in both your previous pregnancies. I understand that your anxiety in this pregnancy is because of the issues in your second pregnancy. However, as per the information that you gave me earlier, in your first pregnancy (which is what we should be going by because it takes away the added complexity of your twin pregnancy) you were contracting all the way through, were on Terbutaline, and had to be ultimately induced. This leads me to believe that your uterine irritability may not necessarily lead to premature dilation this time around as well. In addition, the cerclage is an added protection. I think your OB is doing all he can at this point to manage your pregnancy, without adding more medications than are required.

I do understand that these contractions take a physical and emotional toll. Although you would still need to monitor yourself closely at all times, with your current status, you can be reasonably sure that you are doing all you can.

Hope this has helped .. yes, and we want you back in this forum :) Do update us with your progress.

I agree with your OB’s opinion – transvaginal ultrasound beyond this point will not as informative as an internal exam. In addition, transvaginal ultrasounds are known to sometimes cause uterine irritability and preterm contractions, esp with shorter cervical lengths.

Having said that, with the natural shortening of the cervix that accompanies twin pregnancies, I would also ask your OB if he would be comfortable limiting internal exams to maybe every other week or so, instead of every week. BTW, are you having weekly check -ups?

Paula, it is great that you have been able to carry your pregnancy thus far. It’s good news that both twins are head down – this will give you better chance for a normal delivery. Hopefully you will be able to hang in there for a few weeks longer .. please keep us updated as and when possible.

Sorry for the delayed response. I missed your post amongst the other posts that came in.

To answer your questions:

1. At 31 weeks – 3.3 cms measurement is not bad at all. Research indicates that you really do not need to worry much about reducing physical activity at this point.

2. However, you would need to be monitored every 3 weeks (instead of a visit to the OB every 4 weeks as per normal practice) – If further decreases are found at that point, you can look into decreasing activity levels at that time.

3. For now, I would avoid lifting heavy things, straining at stools, and intercourse just to be on the safer side. In case, there is no further shortening ( or even if shortening is there – but is not remarkable) then you can modify these restrictions again.

4. Swimming should not be an issue; nor should walking. You can continue with both these activities as long as you are not overdoing them. While swimming, I would recommend that you just do regular swimming, and avoid exercises in the pool for now.

Hope this helps .. please feel free to write in if you have any more queries.

I think your website is wonderful and I wish I had come across it sooner.

I just had a few questions and concerns and was wondering if I could have your input. It would be much appreciated.

First of all, I am 37 and had cervix laser surgery at 26 and a cone biopsy when I was 28due to displasia. At 34 with my first pregnancy, I was monitored by a maternal fetal specialist biweekly with transvaginal US to check CL due to these procedures. I was checked between 16 and 28 weeks. My CL did reduce at each visit, and at week 26, I measured 2.4cm and was placed on bed rest (laying on left side as much as possible with bathroom and daily shower privleges and I could grab qick bite to eat from the kitchen) until week 34. My efforts worked and my water broke naturally at 37 1/2 weeks. The only problem was that my cervix would not dilate past a fingertip. Many hours and midwife’s checks later, my OB examined me and found scar tissue holding my cervix together (I assume from my surgery). He cut through it and I immediately dilated to 4cm and gave birth 4 hours later.

Last May, I had a miscarriage at 6 weeks believed to be unrelated to my cervix.

I became pregnant in early October. We had an amnio done with the same specialist at 16 weeks as we dealt with during my first pregnancy. Because he knew my history and wanted to reassure me, he had the technician preform a transvaginal US to get a baseline. It measured 4.5cm. I returned back to the specialist two weeks later for my level 2 US and assumed they would do another transvaginal measurement. I had a specialist, but not the same one as before who told me that because I had carried my daughter to term technically, I would not need to be monitored with this pregnancy with a specialist, bit if my OB felt that he wanted to monitor me, we could do so at his office. Because the US looked great, I felt confident that I could wait the three weeks until my next appointment to discuss it with my OB.

Two weeks later, at 21 weeks I felt as though I was having some type of contraction and felt a heaviness in my vagina. It lasted two days before I called my OB. He told me to come in the following morning for an US. After a manual test of my cervix, he said it felt short, but the only way to determine was an US. I had one and I measured 3.2cm. I was checked again at my normal appointment a week later and measured 3.3 cm. I was also set up with biweekly checks with the US. I was told to take it easy (I have been on pelvic rest since the beginning), avoid lifting, standing for long, and rest as often as possible.

At my 24 week appointment, the technician who I know well and trust with her 30 years of experience told me that I only needed to have the abdominal US because she had gotten such a good view of my cervix. My bladder was full and it measured 4.3cm. My OB was impressed and said that whatever I was doing was working. He said that I still may be a candidate for bed rest later down the road, there was also a possibility of progestrone shots when and if my cervix begins to shorten. He said that we would just assess each measurement and decide what to do from there.

Although I was very happy with the news, I could not help but feel that the 4.3cm reading was incorrect. I know she measured my cervix at different places because she had 4.5 and 4.0cm reading and gave an average and she said there was no evidence of funneling. Could she tell all of that from an abdominal US?

My concern lies in the fact that although I feel very fortunate to have an OB that listens to me and does not want to rush the decision to put progetrone shots into my body and my baby until we really need to, as I get further away from my visits with good news, I panic when I feel pressure or possible contractions. I do feel comfortable with this wait and see mentality and feel fortunate that there are options if my cervix does get to the danger zone as it did in my previous pregnancy.I just want to make sure that I am doing everything possible to carry this baby to term or close enough to it.

For the past few weeks, I have had feeling of localized pressure in my abdomen usually on the right side. I can talk and stand through them (though I am usually laying on my left side relaxing at night when they occur). I have one or two a night when it does occur and sometimes it does not happen for three or four nights. They usually lasts no more than 5 seconds. I never have 4 in one hour. What could this be? I did tell my OB at my last visit and he said that it could be early contractions or the baby just pressing hard. Last night, I only had one as I was laying down on the couch. It made me get very warm throughout my body and the pain went around to the right side of my back. I also feel pressure in my vagina. I have felt this since I can remember and my OB can offer no reason. I have read that one of the IC symptoms is a feeling of a lump or something stuck in the vagina and I wonder if this could be what I am feeling.

I am a teacher and although it sounds crazy my job is relatively low stress even with my middle schoolers. I sit most of the day (my students really help me out and sometimes I feel that they think of this baby as their own little brother). I leave right after school and lay down on my left side as much as possible during the late afternoon and night. My husband is fantastic as he makes dinner and cares for our 2 1/2 year old at night time. Our house is one floor (as is my school), so I do not have steps to climb. A former distance runner, I have not do worked out or done anything physical since week 7. When I get stressed or worried, I usually try to meditate or pray to relax myself. Should I be doing more?

I also worry that the scar tissue that was preventing my cervix from dilating played a role in keeping me from going into labor. My OB tells me that since my water broke on its own that this is probably not the case. He believes that I will dilate faster this time because there is not scar tissue now. He believes that even though the scar tissue stopped me from dilating more than a fingertip, it wasn’t strong enough to hold off labor. I kept thinking the scar tissue was acting like a stitch that I hear a lot of women suffering from IC have done. He said no.

Any thoughts or opinions on my situation would be greatly appreciated.

Hi Dr. Vijaya,
This is my second pregnancy. I had normal 1st pregnancy and normal delivery.Now I’m 18 weeks pregnant and my ultrasound reports says” Placenta is posterior 1.2cm from internal osand shows 0 maturity. My doctore advised me for bed rest and not to travel. Currently i’m in India and I’ve to go back to US. Please advice me if i can travel with precuation or wht should be done in my case.

Hi Dr. Vijaya,
I wanted to update you on my progress. Good news! After being put on bed rest my cervix has climbed back up to 2.8cm! My meds and bed rest seem to be working! I continue to have negative fFN results which is great (though I am still waiting for my results from today…but I am sure it’s still good news.) I asked my doctor if he could change my form of progesterone and he said yes! I will now be getting the weekly shot (instead of the suppository) which is fine with me. Everything seems to working together for good! Thank you so much for your support! I will continue to update you as I progress, but thought you would like to hear the GOOD news!
Thanks again,
Erin

What your ultrasound report shows is that you have a low-lying placenta. Being that you are reasonably early in your pregnancy, there are very good chances that your placenta will pull itself up as the weight of your growing uterus increases. We just have to keep monitoring at regular intervals.

No research indicates that bed-rest is of any help in cases of low-lying placenta. I am assuming that you are not having any other symptoms such as spotting or uterine contractions. If this is the case, you can safely travel back to the US. Your OB may put you on some tocolytic to reduce the chance of uterine irritability during travel, and that should be sufficient. Over and above this, it is recommended that you not lift anything heavy and avoid sexual intercourse as a precaution.

In case you have spotting or uterine irritability, it is better for you to be on a period of bed rest and monitoring, before any decision for traveling is made.

I am currently 27 weeks pregnant and I am being monitored for a shortened cervix every two weeks. I had a cone biopsy 8 years ago. At my visit last week I measured 3.1cm with no opening or funneling. What is concerning me is that my 24 week visit showed the cervix at 4.3cm and at my 22 week visit my cervix measured 3.3cm. The 4.3cm was measured by abdominal US with full bladder, while the rest were measured with internal US. Could the 4.3cm be wrong or can the cervix shorten, grow, and then shorten again?

I have been on pelvic rest and modified bedrest since the beginning of my second trimester. I am still working full time, but sit as much as possible and I do not lift or carry anything. When I get home I lay on my side as much as possible and I do stay on complete bed rest on the weekends. Is it possible that my cervix will shorten at this rate every two weeks? My doctor said a more strict bedrest with no working will be the next step if I shorten to 2.5cm at any of my following visits. He feels that the progesterone shot would be ineffective to start at 28 or 30 weeks. Am I doing enough?

With my 2 1/2 year old daughter, I was put on strict bed rest at 26 weeks with a cervix measurement of 2.4cm. I delivered at 37 weeks. Any input would be greatly appreciated.

Do you remember me? I have been asked questions here last October about short cervix length and early dilation/effacement.

Thank you so much for your help and encouragement. I have been successfully held to 39 weeks and gave birth to my baby boy. I’d like to thank you in this forum and share my experience to encourage others who have similar concerns as me. Here is my problem list:

Dr. Vajaya,
I have enjoyed reading this blog and the responses. Thank you.
I have had 2 second trimester miscarriages due to incompetent cervix. The first was a complete surprise. The second happened 3 days after a sono that measured my cervix at 4cm, and one day before the cerclage placement. I mention this because I am a clear example of how fast a cervix can change in length.

Good news! I am 16.5 weeks pregnant. The cerclage was placed 13 weeks 3 days. I stayed in full bedrest for two weeks before and after it just to be careful. At the time of the cerclage placement my cervical length was 4cm.

Today I went in for a cervical check and they found my cervix to be 1.5cm and holding at the stitch and funnleing.

My questions are:

1) Isn’t 1.5cm low for a cerclage? What possible reasons are there for such a low insertion?
2) I am now on p17 shots once a week. I have no symptoms of preterm labor. Is this just a precaution based on “well, we have to try something?” I’ll still do it either way, after all I gotta try something!
3) They said to take it easy. I said “What is easy”. They said “just take it easy”. I am tempted to stay in bed in trendelenburg position, except for fear of blood clots and muscle loss. What does “take it easy” mean?
4) I can’t find any stats on what my changes of going to term are. With a cervix of 1.5 with funneling is it accurate that I will most probably go into labor 31.5 weeks + or – 5 weeks if I am lucky?
5) Is this pregnancy in real trouble- or is my cerclage doing exaclty what it is supposed to do?

Hi Dr. Vijaya,
I’m back! After receiving good news of my cervix returning to 2.9cm, two weeks later (even with bed rest) my cervix has gone down to 1.9cm (at just over 29 weeks.) My doctor said if I reach 1.5cm he may admit me to the hospital. What do think about this? He said with the increased weight of the baby I was bound to lose more length, but an entire cm in two weeks is too much (especially since I am on bed rest.) Being in the hospital is the last thing I want, since I have an 18 month old son. I am just curious as to what your protocol would be for a patient like me (with no prior history or cervical issues.) I am also now taking Terbutaline (1.25mg every 6 hours…which he will increase to 2.5mg in two weeks) in addition to my 10 mg of Procardia every six hours and weekly Progesterone injections. I am so worried. I just want to make it to 36 weeks! (By the way, every one of my Fibronectin tests so far have come back negative.) I would like to get your opinion on my situation before something like hospitalization happens for me. Thank you for your time once again!
Sincerely,
Erin

You have not mentioned which week you are in .. 50% effacement is not bad in itself; sometimes women can go for 2-3 weeks with even 2cms dilation. However, if you are still not at term (37 weeks), it would be prudent to minimize exercises and activities. Short periods of walking around the house (along with periods of bed rest) should be sufficient to keep you active, and yet not precipitate further dilation and/or contractions.

1. Your internal US measurements are probably more accurate, and hence the ones to go by. The cervix does show some positive increases in length with rest, but not by the extent that you have written, and not in such a short period of time. Finally, sometimes internal measurements can cause more uterine irritation; so you may want to check with your OB if he/she would be ok to measure with abdominal US going forward.

2. You are doing enough with your restricted activities at this time. Even at 2.5 cms, modified bed rest should be sufficient, as long as the rate of reduction is not too rapid. Do ensure that while you are sitting, it is on slightly higher surfaces and not reclining backward, because coming to stand from both a low and/or reclined positions, causes increase in intra-abdominal pressures, which should be avoided in your case.

3. Progesterone shots are not really helpful at this time.

4. What is pelvic rest? I am hearing this terminology for the first time.

Hope this helps …please feel free to write in if you have any other queries, and I promise to be more prompt in my reply next time :)

And, thank you for the detailed update – it will most certainly be useful and encourage other expectant moms in similar situations.

As far as your other question – no there is nothing particular that you need to do (or not to do) in your next pregnancy. We do not know what precipitates many of the issues in pregnancy; and who knows – your next pregnancy may be completely “textbook”! Wouldn’t that be great! Obviously, your OB will maintain a much closer check on your cervical length measurements from early on. Another option may be to go in for a preventative cerclage between 11-13 weeks, which will give you a better chance to go through your pregnancy more actively.

1. Your cerclage placement is doing just what it should be doing. The sudden change in length also correlates well with what happened in your last pregnancy.

2. p17 shots are ok to take. They are given to sustain your pregnancy a bit better. They have nothing to do with premature contractions/labor.

3. “take it easy” is a real scientific term :) Unscientifically, it means avoid lifting anything, avoid straining at stools, avoid intercourse, and avoid too much walking as well as climbing stairs. Short periods of walking (up to 5-7 mins, slow pace) as well as occasional stairs are ok to do.

4. No, there is no accurate way to predict how far you will be able to carry your pregnancy. However, with the cerclage placement and no preterm contractions thus far, it is good news. I would suggest meditation and relaxation techniques, and looking forward 1-2 weeks at a time, so that you are not overly anxious.

With 1.9 cms, you should be extra cautious about what activities you are doing at home. Are you still on strict bed rest?

Even if you get to 1.5 cms, this does not mean that you need automatic hospital admission. You could still manage it at home – However, if your contractions increase in intensity or frequency along with the increased shortening, you may have no other choice but to get admitted, and to be monitored more closely.

Finally, if you do get admitted, it does not neccesarily mean that you have to stay there for the remainder of your pregnancy. It may be possible to monitor you for a few days, and then discharge you if your cervical/uterine condition stabilises.

Thank you so much for your response. Great information and it is reassuring that my doctor is saying similar things. Pelvic rest is simply a nice way of saying no sex!!!

I do have another question. At my last visit three days ago, my cervix did measure at 2.7cm with an internal US. This is down 0.4cm from my visit two weeks ago. Is that too much of a drop? Is this dangerous for 28 1/2 weeks? My doctor does have me coming back next week for another check.

Also, he mentioned that I was funneling only slightly and that he was not too concerned about it given that I had given birth previously and for the fact that I was already on modified bedrest, so he did not place any other restrictions on me. I was not too sure what he meant by this and did some research on my own and everything I am reading tells me that when the cervix begins to funnel that strict bedrest is a must. I plan on discussing this with him at my visit in a few days, but should I be concerned and call him beforehand?

I am still experiencing the tightning of certain areas of my abdomen that last about 15- 30 seconds. Some days I get 3-4 in an hour or only 2 or 3 in a 24 hour period. Are these contractions and could this be causing the funneling and shortening cervix or vice versa? They are by no means painful just uncomfortable. My doctor says that this is okay as long as they do not become consistent and develop a pattern or occur more than 4 an hour. It just troubles me.

Hi Dr. Vijaya, I’m back! :) Just wanted to give a brief update and get any thoughts/feedback you may have. I am currently 31.3 weeks pregnant. At 29.3 weeks my cervix was at 3.1 and today at 31.3 weeks it was 2.93. Not much change over the course of two weeks but I will admit that I begin to freak a bit when it drops below 3. My doc. wasn’t especially concerned by it. He said that basically it had held steady these past two weeks and my cerclage is in place and holding. Also, my baby is quite large, measuring 4lbs 15oz today, which I am happy about! I have been pretty miserable with constant contractions, about 6 an hour, and just getting huge, inability to sleep, etc… I am currently (and have been for two weeks) taking 10mg of procardia and 2.5 mg of terb every four hours. Even with the meds I contract. Today, my doctor said that there was no need to increase meds, move to the terb pump, do an ffn test, or get steroids for baby’s lungs; I asked about all of these things.

I guess I am just looking to get some feedback from you now. If I were your patient, what would you do with me at this point? Also, being that I constantly contract what would your advice be in terms of when to go to L&D? If I followed the standard protocol of “more than 4 contractions per hour” I would be there daily. Thanks so much for your input!

At 2.7 cms, just the precautions that you are taking should be sufficient. In case of further funneling or drop in lengths you may need to be more strict with your bed rest.

We can really not say for sure which leads to what – contractions giving rise to shortening or shortening irritating the uterus, or both happening concomitantly. Some mothers go through shortening, but barely any contractions at all; and some have just an irritable uterus with contractions happening, but no signs of cervical shortening, funneling or effacement. However, do keep monitoring them, and in case they become more than 4 times per hour ( some hospitals use 6/hour as a guideline), they active management would be recommended.

I think everything is going as well for you as can be expected at this juncture. I am very happy with your cervical length at 31+ weeks, and that your cerclage is doing what it is meant to do.

Except monitoring regularly and adjusting med dosages as needed, I would not recommend anything else either. There is really no point in going to L&D at this point in time. Nothing different will be done in terms of managing your condition there versus being at home – which I think is a whole lot more comfortable than being in the hospital.

Second baby: Contractions early 2nd trimester. 19 week u/s showed CL 1.5cm with funneling membranes. They placed emergent cerclage, and CL remained at 2cm throughout pregnancy. Used procardia for irritability. Cerclage removed at 36 weeks, dilated immediately to 3cm/80/0 and stayed there for 6 days. Delivered at 36w6d in 2 hours.

Now pregnant with #3. Moved from DC to Maine, and have whole new team of providers. They are aren’t convinced I need a preventative cerclage, but want to avoid an emergent cerclage down the road when the risks are higher. Since I have two girls, ages just 3, and 16 months, and can’t really be on bed rest, they are thinking the cerclage is the best option for me.

I am in agreement for the most part, but I am wondering how necessary this is. The consensus is that I probably have a normally short cervix, but we are unsure if we want to take the risk. I have no history of miscarriages or losses.

You have to know that this site is amazing and a true gift for someone like myself and obviously for all of the women that you have helped here. I would so appreciate it if you could answer a few of my questions so that I to can be rest assured in my pregnancy journey. Here is a brief run down of my history.

1. Years ago when I was in my early 20’s I had a LEEP and Cone procedure on my cervix. I Later on I got married and at 29 years old got pregnant (last March) I had a rough pregnancy from the start. I had hyperemisis until the 14 th week with on and off spotting. Baby was however great. and healthy. All was well until my 18th week when at my anatomy scan my CL was down from 4.0 cm to 2.0 cm. I pleaded for a cerclage but my Peri decided to watch and wait, Well sadly it was too late and at 19w2d my membranes ruptured and I was admitted to the hospital with antibiotics and held off labor for 20 days. I lost my little girl as she was just to premature and with the lack of fluid she was born still. It twas devestating to say the least and still gieve so hard over her.

2. I am now pregnant again and THIS time my peri put in a cerclage at 13.5 weeks, The pregnancy has been great so far in respect to no hyperemisis and I feel well. I started P17 shots at 16 weeks and take Lovenox for a slight clotting disorder, At my 18 week anatomy scan we discovered that we were having a lil boy and all looked well. As far as my CL an ABDOMINAL U/S SCAN was done with a full bladder and the length was 4.5 cm.

3. Today at my 21 week visit a TRANSVAG U/S was done and the length was down to 3.3cm. *worried*

4. Dr. Vijaya, Could you please explain to me how in just two weeks I am down a centimeter with the cerclage? I know that the first U/S was done abdominally and the second one was Vagianlly but why the big difference (4.7 to 3.3)

5. Which one is more accurate? abdominal u/s with a full bladder or vaginal u/s with an empty bladder? Is my cerclage failing? The CL has changed in just two weeks….???? Is a 3.3cm length worrisome to you at only 21 weeks withe my history of rapid change?

I have put myself on bedrest since the cerclage and for the most part I get up just to use the bathroom and eat. I do however sit up (is sitting up ok). I know I seem worried and I am. I dont know what I would do if I lost another baby. Also, what is your opinion on how often I should be going in for cervical length checks? Bed rest and what not???

I really do think cerclage would be the way to go for you. If you look at how consistent your shortening, uterine irritability (PTL in st pregnancy) and rapid effacement and labor/delivery have been through both your previous pregnancies, it makes no sense to wait for things to get worse before you take action.

As you point out, with two other children, I am sure you would want to be as mobile as possible, without having to worry each time what it is going to do to your cervix.

I would think that the benefits having a preventative cerclage in your case, definitely seem to outweigh the risks.

I cannot pretend to even fathom what it must be to go through a loss – you are a wonderful courageous mother-to-be, going through what is obviously an anxious time in your current pregnancy.

To answer your queries-

1. Sometimes, there is really no explanation for why there are such wide differences seen on abdominal and trans-vaginal ultrasounds. It makes sense to stick to either one or the other, so we can have some consistency in measurements.

2. In women with cerclage placements, the trans-vag US is probably more accurate. However, we have also had many moms with irritable uterine contractions after internal US. So, which method to continue with would vary depending on how the mother does after her internal US.

3. 3.3 cms by itself is not bad. If further internal US shows more dramatic shortening, only then we can comment on how well your cerclage is holding up. Right now, we may be comparing apples to oranges – or at least Washington apples to Granny Smith apples. :)

4. Am I correct in assuming that you are not having any uterine contractions/irritability? Without this, you do not need to be on strict bed rest precautions. Avoiding lifting things, avoiding sexual intercourse, avoiding increasing intra-abdominal pressure as in straining at stools, decreasing number of times that you take the stairs and generally avoiding coming up to stand from low surfaces, should be all the precautions that you need at this time. Further limiting your activity levels may lead to unnecessary loss of muscle strength/tone.

5. With your history, it would be worthwhile to get a check-up with your Peri once in every 2 weeks.

Dr.Vijaya,
Thank you for the quick reply. As I lay here resting I have been checking in for your reply and i am so thrilled to get a response. This site is a miracle and I wish you could be here as my Dr. or at least for a hug. Your caring and compassion is so what I needed.

I wanted to ask after reading your reply… is Cerclage effective? As the baby grows I am assuming the cervix is supposeed to shorten with the Cerclage correct? Once shortening gets to the stitch does all shortening stop? Even with a cerclage can my lCL get lets say down to a 1.0 and still be OK, or will the cerclage rip? Is that likely?

I guess I am just very confused on the Cerclages role…I have a very busy Peri who is not into answering my “dumb” questions which makes it so much more harder. S you have no idea how much your insight meas to me.

Also, in reply to your question, no I dont have contractions or irritablity after the TVU (knock on wood)I will continue to get serial TVU’s. I worry about infection so I take a probiotic ( thoughts on that)?
My reasoning for taking it very easy as I am is to get through the danger zone of the 18-22 week mark, which I have one week left, but am resting and trying to make it to get for the ffn test. Like you sugested, I make weekly milestones and i have a big poster counting down each day til my next milestone.

I will post my updates

Thanks so much.
you truly ae a God send to woman like me
who have faced so many challenges just tring to be a Mother.
I am so glad that I am in good company here

Dear Dr Vijaya,
I came across this website as i was doing my research on incompetent cervix and i must say your comments/advice/answers have been comprehensive more than all other material i’ve read.

Having said that, i’m 31 yrs old and i’m 17 weks pregnant.
Previously i have lost two babies.One at 18 weeks and the second at 22 weeks.In the first pregnancy i woke up and my waters were leaking.The second one i went to my OB with protruding membranes and both with absolutely no pain or contractions at all.
Consequently, i have been diagnosed with a classic case of IC.

This time round my OB put in a cerclage at 12 weeks.I was on moderate bedrest for two weeks and after that i’m now back to working.

Having given my background, i have some concerns which i hope you’d be kind enough to address and hopefully it can also be of help to women going through IC.

1.My work involves sitting for long hours:9 hrs.Is this healthy for me? is sitting better off than standing?

2.My office is on the mezannine floor(no access to lift) and i usually have to use the stairs about two trips a day.Is that safe considering my condition?

3.When i had my cerclage at 12 weeks my OB prescribed no antibioticts and even when i requested he said i dont need them.So far everything has been fine but i’m very scared because i’ve come across many cases of infection.Should i be concerned?

4.I have also been diagnosed with multiple uerine fibdoids measuring between 1.5-2.4,am.Does this make my IC case worse?

I just saw my dr 3 days ago, I am 20 weeks. My cervix has shortened to 2.9cm, I had a LEEP almost a year ago my doctor only advised me to rest and I will see him again next week. I am nervous that rest alone might not work… Is there anything else I can do? Or something I should ask my doctor to do?

The nature of cervical shortening is such that sometimes the cerclage works super-effectively, and mothers go post-dated into labor, post removal of cerclage! In other cases, no matter what you do, even with a cerclage, pre-term labor can start. Unfortunately, there is just no way to know for sure if cerclage will be 100% protective in a particular mother.

To answer your particular question, your cervix can get really short and hold up, provided there are no uterine contractions at that point. The efficacy of the cerclage can become much lesser with constant pre-term uterine irritation/contraction. Having said that, many a mom has held up with cerclage, uterine contractions and medications all the way to term. So, overall – when done under appropriate circumstances (yours definitely qualifies as appropriate), the cerclage has a good chance of doing what it is meant to do.

I have one question though – why the Ffn? Without signs of PTL it is unlikely that Ffn will be positive. Is it just being done to cover all bases, because of your previous history?

Countdown is a good way of keeping your spirits up! I know it sounds crazy, but sometimes it is good to try and look at all the positive aspects of your pregnancy; that way you are also counting up to something. Along side your check off calender, each day try and write one positive thing about your pregnancy to your baby – perhaps one day you can share them with her/him.

I am so sorry about your previous losses, and am really glad that you have had a preventative cerclage put in this time, and that it is holding up reasonably so far.

2.5cms at 17 weeks is borderline on the shorter side, but with your cerclage, it should hopefully hold up.

To answer your other queries:

1. Prolonged sitting really does not have anything to do with cervical length. However, as with any pregnant mom, I would not advise sitting continuously for more than a half hour at a time. You need to get up and move around for a bit, so that you promote circulation and decrease incidence of backache, especially as your tummy grows. We also know form experience, that if you sit in semi-reclined or backward tilting positions (as is done by leaning back on office chairs) for long periods of time, it predisposes you to carrying your baby in a posterior position, which then prolongs the length of labor. So, ensure that while sitting, you use a pillow behind your back and sit as straight as possible, and ensure small stretch breaks every half hour or so.

2. For now, your staircase trips are ok. In case there is any dramatic shortening in your next visits, then we can revisit this issue at that time.

3. Antibiotics at 5 weeks post-cerclage, are not required. If any infection were to set in, it would have happened by now.

4. Uterine fibroids can place more stress on an already compromised cervix, if they are big. It looks like your fibroids are comparatively small in size, and so should not cause you too many issues, unless they grow bigger during your pregnancy. Again, you would have to wait and watch as your baby’s weight increases, as to the combined effect of that and your multiple fibroids.

Hi Dr. Vijaya,
Wanted to update that at 32.3 weeks my cervix measured 4.1….yippee! This is even with non-stop contractions. I am beginning to allow myself to be hopeful even though, truthfully, the worry will not cease until I hold my baby and know she’s OK……and, actually, that’s probably a lie too, because I have a 10 year old who I still worry about, but now I’m straying from the point a bit :) Anyway, just wanted to check in. I read all of the questions and posts that come in here and I appreciate all of the info./advice that you offer.
Heather

2.9 cms at 20 weeks is not that bad at all. In fact, if it were not for your previous LEEP procedure, I wouldn’t be even inclined to put you on bed rest. Research shows that no restriction of activity is needed at this point.

Having said that, in case there is further shortening at your next check up, you would have to take the bed rest advise seriously and restrict your levels of activity depending on the amount of shortening seen.

Cerclage at 20 weeks plus is not really recommended in women with 2.6+ cervical lengths, and with no previous history of second or third trimester losses. Having a cercalge doen at this stage in your pregnancy can actually trigger uterine irritation and this is something that you don’t need.

So, all in all your OB is doing all the right things; he will need to monitor you every 2-3 weeks for the rest of your pregnancy.

Great going :) I am sure other moms reading this can take heart .. non-stop contractions, and cervix is still holding up! You must be using all your mental strength to tighten that cervix and hold it!!

I know about the worry part – I have a 11 year old and a 9 year old; only the focus of the worry changes – anyways they will be all grown up soon.

Thanks for the update … good luck!

I am going to sleep for a few hours .. it’s 3:45 am in the morning on my side of the world!

Dear Dr Vijaya,
I cant thank you enough for your response on my queries.I was soooo excited when i saw it!
I’m a big fan of yours and the first thing i do when i get online is to look up any new postings.

This website has been such a wonderful resource! I wanted to get your opinion on my case. I am 21 weeks along with my second child. I had a miscarriage at 5 weeks before my daughter who is now 3 and had a missed miscarriage that necessitated a D&C. I went into preterm labor with my daughter at 35 weeks, but after a shot of terbutaline she held on for 2 more weeks until my water broke at 37 weeks. After 12 hours of pitocin and contractions, my cervix never dilated and I had to have a c-section to deliver my daughter.

After my daughter I suffered 2 more missed miscarriages. One at 12 weeks and the other at 6 weeks. I had to have D&Cs after both of them after waiting for a month for each to pass after fetal demise. It was difficult.

For this pregnancy, at my 18 week anomaly scan the dr noticed that my cervix was “short” at 3.3 cm with a slight bulging/funneling of the internal os. Since then I have been going weekly for transvaginal scans to and external scans to see if my cervix is shorter and it has stayed the same. I have been on modified activities since 18 weeks.

Should i continue weekly checks on the cervix if it is showing 3.3 cm? IIs 3.3 cm short at 21 weekss? Is there a danger of incompetent cervix because of the 3 D&C’s? My dr seems to think that if the cervixis the same at 22 weeks then we can go to every 2 week checks and then just worry about pre-term labor and not IC. thanks for your thoughts on this!
Annie

I think you are on the right track with your OB’s recommendations. 3.3 cms is really not “short” as in “cause for concern”. However, due to your previous history greater monitoring is definitely worth it, until you get to 22-24 weeks. After that, every 2-3 weeks of monitoring should be pretty much what would be required.

I am writing on behalf of my wife. We are 22 weeks pregnant and received word last week that my wife has a shortened cervix. The measurement was 2.5cm, cervix is closed, and there is was no signs of funneling. What we were told by our doctor was that this is a borderline case. She actually even indicated that we have the option of putting in a cerclage, but from everything I have read, it seems this is a risk not worth taking at this point. What is your opinion? My wife has been remanded to bed rest, with the exception of getting up to go to the bathroom and shower. Is this really necessary at this point and how does this exactly help? Are we still at risk for pre-term labor? We have decided to switch care to a high-risk OB/GYN as we feel they are more qualified to direct us through this. Would you agree? Please tell me what you would prescribe at this point and how often should her cervix be measured? Finally, at what week when can a FFN test be performed? Thank you so much for your care and help.

2.5 cm is borderline short. With no previous history of procedures or miscarriages, monitoring every 2 weeks would all that would be required. Switching to a high-risk specialist is not an absolute requirement, but probably makes sense, in case the condition requires more stringent monitoring due to decreasing cervical length.

At this point, just reduced physical activity is ok to follow – this means: that your wife can walk about in the house, but should avoid stairs, long periods of standing or sitting, lifting anything, as well as coming to stand from low furniture. She should avoid straining at stools and anything that increases her intra-abdominal pressure. Barring this, strict bed rest at this point is not really needed. With further check-ups, in case there is more shortening, she can be on complete bed rest at that time.

Finally, with your wife’s current status, Ffn is not really needed. Only if the cervix shortens remarkably, and starts to dilate, or your wife starts having symptoms of preterm labor, would an Ffn need to be done.

Thank you very much for your response. We definitely found it helpful. We are no under the care of a high-risk doctor and will be measured every week. Our measurement this week came back at 2.8cm. So the cervix actually lengthened from 2.5cm a week prior.

It was our understanding that cervix can not lengthen but only stay the same or shorten. Does bed rest help to lengthen it as well?

Finally, how reliable are the cervical measurements taken via the ultrasound? Is it possible for the tech to get it wrong and we actually are still at 2.5?

hi doctor im 27 weeks pregnant and have a cerclage placed in since 12 week because of imcompetent cervix and pretem labor and preterm birth.A week ago the doctor said my cervix is thinning already even with the cerclage in place im having alot pain in my private area and a lot of pressure and lower back pain my first was born at 27 weeks because the water broke even though i dont know why probably because my cervix couldnt hold and i had a cerclage with her to i was just wondering what do you think are my chances of the same thing happening again with this baby. my doctor checks me but says that its thinning but its still closed im just worried because my first was born early at 27 weeks and dont know what to expect with this baby thanks ahead of time

Sometimes, in spite of all we do, the cervix continues to thin out and dilate, and/or the bag of waters breaks. I would just recommend very strict bed rest, and following all the precautions that your OB recommends. Are you having check ups weekly?

I wish I could be of more help – but I think other than resting and monitoring yourself very closely, nothing more needs to be done at this point, esp since you already have a cerclage in place.

Good Luck – please do write if you have any other queries or concerns ..

Hi Dr Vijaya,
I wrote to first about two weeks ag(April 15th) seeking your opinion.
I’m currently 1 day shy of 19 weeks having had a macdonald stitch done at 12 weeks.So far all has been well-knock on wood except for a few concerns which hope you can address.

1.I’ve not had sexual intercourse since the cerclage.Lately i’ve been having orgasms in my sleep causing me alot of tightening around my stomach,accompanied by contractions which i can feel around my cervical area causing me a very uncomfortable feeling which i can describe almost as pain for lack of a better word.I’n very worried about this because i have a feeling it could have contributed to my earlier rupture of membranes at 18 weeks when i woke up ina pool of water.I spoke with my OB regarding this during my 17 weeks appointment and he seemed to down play my concern.However experience has taught me to heed my inner voive and thats why i’ve had to talk about such intimate details in this forum because i need someone else opinion.Dr, have you by any chance come across this or are you familiar with this?

If i were you patient,what would you recomend?
2.At my 12 week ultrasound my CL was 2.5cm.This last friday i went in for onother U/S and this time round my CL was 2.05cm(initially the Dr did a normal one which showed 1.6cm but i insisted on an intra vaginal one which read 2.05cm).Should i put myself on moderate bedrest or can i still continue working 5 days in a week?
Is there any risk of getting an infection from having an intra vaginal U/S as opposed to the normal one?

Being a day shy of 19 weeks i know i’ve entered the danger zone(i’ve had 2 losses between 18-23 weeks) and i’m very scared.Sometimes i wish i could just hibernate and resurface after week 24!.I hope you can understand my fear/concern and help be the best way you know.

Sorry for the delayed response. We have had a few high risk moms in our hospital, which have been leaving me with time for little else. We have also started our own birthing center, dedicated to natural childbirth, and this has taken quite some time and effort to get things into place.

To answer your questions:

1. Yes, and no. Yes, I have heard some of my expectant moms talk about not only vivid dreams and nightmares during pregnancy, but also of orgasms in sleep. Typically though, it is more towards the end of their pregnancy. However, I have not had anyone have uterine irritability, repeated contractions or breaking their bag of waters as a result of this.

2. At 2 cm or so, you should be monitoring yourself extra carefully, and would recommend that you be on modified bed-rest. Which means that you can walk about in the house for very short periods of time, should avoid stairs, long periods of standing or sitting, lifting anything, as well as coming to stand from low furniture. You can be semi-reclined on the bed for short periods of time, and alternate between this position and sitting, along with lying down. Have lots of fluids as usual. A dehydrated uterus is not a happy uterus and can start getting irritable. And, get your check ups done every two weeks.

3. Going to work at this point, does not seem like a good idea; work form home if you can. It makes sense to take the maximum precautions at this stage, especially considering the time period within which you have had your previous losses.

Just wanted to do our 2 cents for this forum by posting our experience with this forum and how it kept our hopes alive. So here is our story in nutshell.

Till 21st week our pregnancy was cruising till we went for our 3 month US where the technician pointed out that my wife’s CL is 1.4 cm.

OB puts my wife on complete bedrest was not very hopeful about the pregnancy in general. My wife was shattered and we almost gave up hopes.

Wife was put on Niphidipine and progesterone shots. Was the best thing that happened to us. Niphidipine proved very useful in our case and so did the shots i suppose.

Come 26th week our OB switches hospital and we followed her and the new High Risk specialist thinks the CL is normal ie 3.5 cm and closed. The first C-section mark was misunderstood by the technician and Cervical Shortening.

Several close moments where wife’s would have back pains and tightness of stomach plus all the complications resulting from bed rest. Week after week passes by and we finally reach 36 weeks and wife is finally 3 cm dilated. Pregnancy continues till 39 weeks and our beautiful baby boy was born April 20th. Cant thank enough Dr Vijaya and everyone on this forum for all the tips and assurances that kept our hopes alive in this long and bumpy ride. A big thank you!
Nick

I know how hard it is for families to go through a high risk pregnancy, so I must say, hats off to you all who sustain your hopes and energies and go through what is definitely a trying and often tiring process.

Thank you for coming back to this forum and updating us – it is stories like yours which help other families in similar situations to get the courage and the strength to go through their pregnancies with hopefulness.

Also, thank you for your kind words. It is always my belief that the more the mother and father feel supported during the antenatal course (high risk or not), the outcome for both baby and mother become better, come time for labor and delivery. This forum, is really a very small part in trying to give some amount of that support.

I found this page by checking the Internet for the issue of short cervix. I found your answers really helpful and since I am living in China far away from my home in Switzerland I’m always a bit helpless with all the questions and worries I have about my pregnancy.

I am currently 24 weeks pregnant with my second baby. I had my first daughter in February 2008. With my first pregnancy I felt fine until about week 28 when I thought I had a lot of contractions and got checked out. My cervix was 1,5 cm and soft. They put me on bed rest and gave me terbutaline 2,5 mg oral. My contractions never stopped – I had them about every 10 minutes sometimes even more. I had another measurement of he cervix at week 36 and it was still 1,5 cm. I stopped the medication and got of bed rest by week 37 and had my daughter at 39 + 3 days. Labor was 5,5 hours.

Now with my second pregnancy the contractions started around 19-20 weeks – now at 24 weeks I have about 4 sometimes more contractions or uterine irritability – I don’t know what I should call it – per hour. They are the same contractions as in my first pregnancy – painless tightening of the uterus. Mostly more on the right side than the left side – also like the first time. They measured my cervix abdominal at 18 weeks 3 cm, at 21 weeks 4 cm (I had a full bladder then which I didn’t the first time) and at 23 weeks 2,75cm – but this time they didn’t measure abdominal but vaginal bit not inside my vagina just from the outside – I think they did it this way since I had an empty bladder. What measurement do you think I can count on? I’m really confused about this different numbers since I was so happy with the 4cm at 21 weeks.

I started with the terbutaline oral again but it doesn’t seem to help – like it didn’t help in my first pregnancy with my contractions/irritability. I’m not sure if I should take the medication anyway or if my uterus is just contracting and I have to get used to it. It is really hard for me since I always concentrate on the tightening to see how much I have per hour.

They didn’t put me on bed rest but said to take it easy and lay down often. What do you think should I be on bed rest more strictly? I am just afraid that I don’t do enough to calm down the contractions. Have you heard of a uterus just contracting all the time and never stop until delivery? I asked this my doctor here but she said that she didn’t have a case of uterine irritability from so early on.

She also checked my cervix last time at week 24 and said that it was kind of soft. Is this really bad or can it be soft anyway since it is my second baby and it was soft the first time too?

We also would like to travel home in 4 weeks – do you think this is a problem if the cervix stays stable?

Thank you so much for you answer. I just feel so alone with my problems sometimes.

1. There are many moms who go through this uterine irritability and do just fine, just like you did the last time around! (Also read Heather’s entries on this forum – I think you will find a lot of similarity in what you are going through).
Sometimes, I wish we could just leave expectant mothers like you alone and not give any instructions for medications/ bed rest and see how the pregnancy progresses. Truth is, we cannot do that, and we have to try and do our best to ensure that these contractions do not intensify and predispose you to preterm labor and/ or fetal distress.

2. Meds may or may not have any eff\ect on the degree of irritability. So you have to ask your OB to perhaps play around with your meds and see which one works best to decrease the irritability for you. Nifedipine would be one option, which has worked out well in many moms. One of the things that would have to be monitored with this, is your blood pressure since it can become a bit low at times.

3. Cervical length measurements – I would any day go with the full bladder measurements. Having said that, the more accurate measurement can be obtained intra-vaginally, but has to be done by a skilled technician and be read by a good sonologist/ high-risk specialist. Whichever way you go, I would keep it constant – so that you know how stable your cervix is.

4. Even if we go by the 2.75 measurement, at this point there is no need to restrict activity. Just be careful to not overdo physical activity, take ample rest, and avoid sexual intercourse for a few weeks until you know how stable your cervix is. In case, the length shortens further, we can then think about reduced physical activity or modified bed rest.

5. If your cervix remains stable, and more importantly, your contractions do not intensify, then there should be no harm in traveling home. Your OB may prescribe some tocolytic (muscle relaxant) a day before the start of your journey, to be continued until you are back home to avoid increase in contractions while you travel.

Dear Dr Vijaya,
Thank you for your response.
I’m scheduled to see my OB this coming Wednesday.Currently i’m not on any medications.Is there some medication you would recomend for me considering my condition?

Hello Doctor, Vijaya,
I am 21 weeks pregnant with twins. I’ve had two UTI’s and currently on amoxicillin. I went in to the doctor and they said my cervix is 3.2 and a pelvic exam showed it hard. What is the “normal” and safe cervical length for someone with twins? This is my first pregnancy. The UTI is causing pain in my abdomen and tightening. They said once clear the UTI, this should stop. Is this true? Should I be concerned that the UTI can cause preterm labor? Thank you very much. Laura

3.2 cms at 21 weeks, with twins is very reasonable. No softening of the cervix further indicates that it is not predisposed to thinning and dilation at this point. This is good news. Once the UTI clears up, there should be no further irritation, and therefore not much chance of preterm labor. Having said that, many mothers with twins pressing on their cervix will go into preterm contractions even without the UTI. But, an equal number of mothers have no such symptoms as well! So, we will have to wait and watch in your case. With no other predisposing factors, you have a good chance of all this clearing up once your antibiotic course is complete.

hi and thanks Dr. Vijaya for your response well i go once a month and im very worried because i have alot of pressure in my area and alot of back pain at times i feel like i have to use the bathroom but when i go nothing i just feel alot of pressure in my area and alot of tighning (sorry for the spelling) in my uterus and my belly is always rock hard. im very uncomfortable cant sleep at night and my doctor every time i tell him about my concerns just doesnt seem to care. i believe i should be seen weekly or every two weeks but he doesnt think so. he didn’t tell me to be on strict bed rest just to try and hold at least until 30 weeks even though he wants until 36 i dont know what to do i dont trust my doctor and dont think somebody else would see me due to the fact that im almost 7 months. what could i do? i would appreciate your opinion thanks

Having constant tightening and hardness in the belly is not a great sign. Are your being monitored with a CTG? With continuous hardening, the baby can get into fetal distress, and the reactivity patterns on the CTG monitor can often be a good indication along with a biophysical profile. You should ask your OB about this.

Secondly, are you on any medications? With your current set of at least a trial of meds would be warranted.

Finally, if your doctor is not responsive to your concerns, I would think it is time to change to someone else. It is your right to look for a care provider who not only listens to your concerns but also does his/her best possible to address them and give you true informed consent for all that they try or do. If you do not change now, then when?? Most providers will accept patients at any stage of pregnancy. And, in my experience, mothers who are strong in expressing their opinions, are the ones who receive the best care. It is your body and your baby. If you feel that you are not receiving optimal care and attention, demand it!

Sorry to sound so opinionated, but I have very strong feelings about quality of care, antenatal counseling and true informed consent …

If there is anything more that I can help you with, please do write.. Good Luck!

I just wanted to send you an update- your comments were very helpful to me when I went on bedrest at the beginning of January due to a shortening cervix and irritable uterus. I ended up in the hospital for the final two weeks of the pregnancy due to pre-eclampsia, but after 102 days of bed rest, delivered two healthy twins via c-section at 36 weeks 2 days on April 19th! My daughter Amani weighed in at 5 lbs 3 oz and my son Karim at 5 lbs 1 oz. Neither needed any time in the NICU and they are both at home with me now, gaining weight and doing great!

Thank you so much for providing this wonderful resource and taking the time to answer questions and give support. It is much appreciated!!

Having known your condition from almost 23 weeks, it feels great to have you back and post an update .. and such a wonderful, positive one at that! 102 days of bedrest .. wow .. and it all paid off in the end. I am sure many mothers on this forum will take heart from your experiences.

Dear Dr Vijaya,
I’ll just go straight to the point to save on time.
I have come across the 17p-Alpha hydroxyprogesterone caproate which i gather is a form of the hormone progesterone.My question is,is it any different from regular progesterone medication?
The reason i ask is because i would like to know if i should be specific when asking my doctor on his opinion regarding putting me on it or will any kind of progesterone do?

I have my 20 week appointment this coming Wednesday and would as always want your input on this.

Any form of progesterone will do just fine. Progesterone just helps with sustaining your pregnancy and is used as a pregnancy insurance. Sometimes it helps, and at other times it is not so effective, but it gets prescribed just to ensure that we are doing everything we can to protect the pregnancy.

Thank you for your reply. I have had an update and wanted your opinion on it. At my 22 week appt last week my cervix funneled more and it was measuring 2.2 cm, My dr. was alarmed and ordered a fetal fibronectin test (which was negative) and I am now on 17p shots for the next 10 weeks. He ordered strict bedrest that day and had me come in the very next day for a NST and another measurement. It measured 2.8! In one day! Does that make sense?

Anyway, I was on strict bedrest all week and I went in for another measurement yesterday and it was the same, 2.8 at 23 weeks 3 days. He will be ordering another fetal fibronectin test next week. My Dr. thinks I will be out of the woods with IC after next week and we only have to “worry about preterm labor.” Does that make sense to you??

Thank you so much for your thoughts – I greatly appreciate any advice you can give.
Annie

At 2.8 cm, all you will need to do is take care not to overdo physical activity in terms of stairs, squats, sitting/standing up from low furniture. Rest, you need not even be on strict bed rest. We often find that mothers get extremely deconditioned, have backache and develop pelvic ring pain with strict bed rest. So, we avoid it unless the measurements are alarming.

As fro Ffn, I am not sure what prompted him to do this test. Again, except in cases of extreme shortening or symptoms of uterine irritability, Ffn is not really required. In any case, it is good that it is negative. You do not have to worry about PTL at this point at least.

Just getting monitored once every other week would be the research recommended protocol, if your cervical length holds around the 2.6 or above mark.

Dear Dr Vijaya,
I saw my OB for my 20 week appointment and he prescribed deanxit.I googled its uses and i’m confused as to why he prescribed this.
Would you have a reason as to why i was put on this? i’m yet to start taking the medication.

Dear Dr Vijaya,
I did ask what it was meant for and was tolt will help me relax.
However when i googled i had serious reservations about it.
The only thing i told my OB is that i’m very scared of these coming weeks, and rightly so! i’ve had 2 previous misfortunes.
Anyhow my insticts already told me i dont need that medication and i’m glad you have affirmed my sentiments.
I’ve noticed my doctor is really into medication,anytime i see him he must prescribe.

Will keep you posted.As always, many thanks.(wish me luck-i need to get to my next milestone which is 24 weeks!)

All my very best wishes to you … keep up your spirits, do some meditation and deep breathing exercises daily, and listen to calming music if you can. This will help you and baby to tune into each other – and help you relax as well!

First, I’d just like to say that your answers and comments provided a lot of very informative and interesting insight. My wife is in her 28th week of pregnancy. She was diagnosed with cervical incompetency in her 20th week of pregnancy. Her cervix was 20mm at her 20th week and shortened quite substantionaly (especially in her 26th week – measured 5mm). She is now in hospital on a really strict bed rest. I was wondering whether there is a correlation between the week of pregnancy and probability of preterm delivery? I mean, if for e.g. her cervix were 5mm at 20th week and at 28th week is there a difference in chances of preterm delivery? (of course, I’m aware that there is a huge difference in child’s chances of survival)

With remarkable shortening in the 20th week, was your wife not offered an option of cerclage? Even though cerclage carries a risk of uterine irritation, with remarkable shortening, it gives the expectant mom a better chance.

Now, with 5mm measurements, the only way to go forward would strict bed rest, as you are already doing. Although the chances of preterm labor do increase with greater and greater shortening of the cervix, it is known that may women do carry their babies to term or near term with bed rest, medications and medical supervision.

Thank you so much for helping me through this – I really appreciate it! I just wondered if you could tell me why my cervix showed 2.2 cm at 22weeks and then went back up to 2.8 cm in a week at 23 weeks? My doctor said that the funneling was worse when it was 2.2 and the funneling was better when it was 2.8 cm. Both times they were measured by the same, high risk ob, through transvaginal ultrasound.

Should I be feeling more confident about my situation that it was still about 2.75 cm when I went in for my 24 week appt? I am still on bedrest – I only get up to shower and use the bathroom. My doctor thinks I should do this to prevent further shortening like what happened at 22 weeks with the 2.2 cm. I want to be doing the right thing and I am terrified of walking around more and causing more shortening like what happened at 22 weeks. Right now the baby is laying transverse so she is up and off my cervix which is good – could things change if she ends up moving and pressing on my cervix? I am so worried.

Thank you for listening to my concerns and helping me through this – I tend to be a worrier so this situation is NOT good for me!

Sometimes, with strict bed rest, we do see remarkable increase in cervical length. However, we have also seen good increases in length without doing anything … go figure! Without sounding terribly unscientific, sometimes we are still trying everything in our bag to try and sustain the pregnancy without knowing what might help in the end. This is one area where lots more research is still needed.

So to answer your question, it is good news that your length is back to 2.75-2.8 range. If it remains in this region over the next 2-3 weeks, I would recommend that you can try limited activity and small bouts of walking around the house at that point of time.

I understand that it would be tempting to maintain “bathroom privileges only” routine – however, with bed rest come a lot of other issues including muscle weakness, pelvic ring pain, positional hypotension etc . So, if your cervix remains stable for the next few weeks , it would be a good point to re-evaluate your activity levels, and let you be a bit more active (and a little less worried :) ) at that point of time.

As far as babies’ presentation is concerned, nothing we can do about it. When baby turns head down, we can look into what that does to our cervix at that time. Hopefully you will be further along into your pregnancy at that time, where you would not have to worry about shortening.

Unfortunately, my cervix shortened considerably this week and I am now at 1.9 cm at 25 weeks. After being monitored for contractions my dr. felt that i didn’t need terbutaline b/c my uterine irritability was mild. He doesn’t think that this is causing the shortening. I am home on strict bedrest – bathrooms and showers only and taking it day by day. I am so worried now that after all that resting it still went down. Good news is the cervix is still closed…and there is hope that maybe the cervix will lengthen again. Good news also is the baby is growing really well and is already over 2 lbs at 25 weeks!

Thank you very much for your response. We definitely found it helpful. We are no under the care of a high-risk doctor and will be measured every week. Our measurement this week came back at 2.8cm. So the cervix actually lengthened from 2.5cm a week prior.

It was our understanding that cervix can not lengthen but only stay the same or shorten. Does bed rest help to lengthen it as well?

Finally, how reliable are the cervical measurements taken via the ultrasound? Is it possible for the tech to get it wrong and we actually are still at 2.5?

Our doctor is planning to give my wife the FFN test next week which will be 26 weeks. But he said not planning to give the corticosteriods shots as of yet. What is your thought on this?

Yes, we have seen increases in cervical length with bed rest. Having said that, we really do not know the mechanism through with this happens, thought here are some theories out there.

As far as measurements by ultrasound, it depends on the skill of the technician, how full the mother’s bladder is at the time of evaluation and whether the US is done abdominally or trans-vaginal. It would be highly preferable to keep all these factors as constant as possible to get the most accurate picture on follow up visits.

In our own practice, despite keeping so many of these factors constant we still get widely varying results with ultrasound at times – baffling to say the least! We then try and correlate it to the clinical picture, so as to give the expectant mother the best possible line of care.

Why do you need the Ffn test? If there are no signs of preterm labor, and if your wife’s cervical length remains stable, there would be no clinical indication to do this test. You might want to check re: this with your OB. My rule of thumb – do only what is required – no more, no less. This avoids over medication and interventions – which can be only good for both mom and baby.

Steroids – again not required. If physical signs of preterm labor are present, cervical length is very short, and then an Ffn is done., and if this come positive – then only steroid would be advisable. Research shows that the efficacy of the steroids lasts only for 2-7 days; and that repeat steroids are not beneficial. So, makes sense to get this administered only if medical indication is there.

I am currently 19 weeks pregnant with twins and during my 17th week of pregnancy I had a clerage. At 14 weeks I measure 3.4 cm and then at 17 weeks 2.6, but one of the babies heads was leaning on my cervix, my doctor suggested I get the cerlage done because it shortened so fast. My next ultrasound isn’t until May 21 and I am very worried.

After having had the surgery I read articles that suggest clerage should not be done on a twin pregnancy because it raised the chances of premature labor even more. I am very worried, my babis are ivf babies after ten years of trying to get pregnant and two ectopic pregnancies.

What are my chances of having these babies. Should I be on strick bedrest or is the couch rest and walking less then 500 m a day, what my doctor suggested, ok.

With twins, and with the shortening, it was probably the right thing to get the cerclage done. Despite this, you may have further shortening and go into premature labor – however, this would not be because of the cerclage but in spite of it. On the other hand, you may be able to carry the pregnancy as close to term as possible – we have definitely seen both ends of the spectrum! (Do read Az’s posts on this forum – it will probably give you some encouragement and hope!)

I do understand your anxieties and concerns with your previous history – but, hopefully you will be able to continue with your pregnancy safely this time around.

As regards activity, if you are monitored only a biweekly basis, and if your cervical length remains relatively stable, you should have no issues with limited walking and sitting up. I do not like couches though. Getting up from low couches increases pressure in the abdomen which you should try and avoid. Also, sitting reclined in the couch gets the baby (ies) into less than optimal position, making it harder for natural childbirth. You can use regular chairs instead. Being reclined on bed/couch for short periods of time during the day is okay.

hi dr i went to my ultrasound today im currently 29 weeks and they told me that i was 1.7mm and funneling dont understand the funneling part my question or concern is is this normal or should i be worried because he only sees me once a month and doesnt say anything just the ultrasound tech is the one that informs me whats going on and also he didnt tell me to rest or anything please let me know what you think and what should i do. thanks hoping to hear from you asap thanks

I am really unsure as to why your OB is not seeing you more frequently – especially with your previous history. At the cost of repeating myself – see if you can change your care provider. It may make all the difference in the world.

It is baffling to me that the technician is communicating results to you, and there is no further counseling or medications/plan of care being discussed with you. Since I cannot really know how you are physically, I cannot recommend anything other than bed rest to you. However, you are right in worrying about your plan of care – and you need to take matters into your hands and change to a provider who can work with you to ensure that you carry this pregnancy forward in a healthy manner.

I am just here to tell everyone that I had an ultrasound today and my cervix length is back to 3.4 after my cervical cerlage. I still have to be extra careful and rest most of the day because I am having twins and my cervix can shorten permaturely again but at least now I know that the rest is doing it’s job.

Hi Dr. Vijaya! I just wanted to touch base and let you know that I ended up delivering a healthy baby girl at 37 weeks 1 day! I made it!!!!! What an amazing and healing experience to hear her cry after such a long, scary road. I wanted to thank you for the information and support you offered throughout my journey. I hope that others can receive encouragement from my success. With warmest regards,
Heather

It is truly wonderful to hear wonderful, patient and courageous moms like you come back and share your experiences and successes. Having known you on this forum from around 23 weeks, I feel glad that I have been a small part of this journey.

Hi Dr Vijaya,
Hope all is well with you.The last time i wrote to you i was in panic as i was entering the danger zone.I’m glad to be 25 weeks! Tell me:

1. I’ve heard peole say that after 25 weeks the baby somehow lifts/gets off the cervix there by reducing pressure on the cervix.How true is this?
2.Now that i’m 25 weeks, can i consider myself out of the woods with my condition?
3.I’m considering taking the ffn test just for my own peace of mind.Do you think this is necessary(i’ve had no contractions at all so far)

1. No, baby does not lift of the cervix – in fact in many cases, as the baby’s weight increases and pressure is applied on the shortened cervix, it actually leads to further shortening, dilation, contractions or all of above. Having said that, in great many instances no further shortening or dilation happen until closer to 37-39th week. Perhaps what you are hearing about is about low-lying placenta. This corrects itself in 70% of the cases, around 25-28 weeks, and pulls itself up.

2. 25 weeks is great from your point of view – however, you would still need to be monitored every 2 weeks or so, until you reach 37 weeks. 28 weeks would be your next milestone, as that would be the baby would have very good chances of survival even outside the womb, in case you start having pre-term labor.

3. I do not think Ffn test is required at this point. However, with your previous history of painless dilation and protrusion of membranes, it may be worthwhile simply for your peace of mind- as you so aptly put it. Can’t do any harm. However, I would not recommend repetitive Ffn, as sometimes this can trigger uterine irritability.

Dear Dr. Vijaya,
Thank you so much for providing this oasis in the desert, I feel so relieved to be reading such informative answers to all these questions which have been at the forefront of my mind.
If I can seek your opinion in my case I’d be most grateful. I’m currently 21 weeks and 1 day pregnant with my second child. The first went full term and after a traumatic labour which ended in C section, my 8lb 13oz baby is now a healthy 21 month old boy. My 20 week scan last week showed that ‘internal Os appear open with marked funnelling and a closed cervical length of 1.3cm’
The consultant seemed fatalistic about my chances of a successful pregnancy and commented that she’d had to induce women with similar scan reports. She advised to slow down, but there was no mention of bedrest. She also stated that studies were inconclusive as to whether cerclage would be of benefit in my case. She thought that as I’d carried successfully once I shouldn’t have a problem?
Since reading the information on your very helpful website, I’ve gone on bedrest and called home my husband who was working away home. The consultant requested I have a further scan in 4 weeks, is there anything I can do other than keep on bedrest, I’m using the bathroom and making snacks and drinks? I’m taking each day as it comes and hoping all will be well.
Many thanks again,
Kate

Sorry for the delayed response. Things have been a bit hectic at our Birthing Center.

I have a couple of questions:

1. Was your scan an internal scan or was it done abdominally?
2. In your previous pregnancy was there any cervical shortening noticed?

I agree with your OB that cerclage at this stage, would not be the best option. It might even land up triggering premature uterine irritability.

I would definitely suggest that you continue bedrest. Granted that studies are equivocal as to whether bedrest has any true benefits, but for many, many moms in our practice, this does seem to help at least to some extent. Getting up for bathroom and minimum food prep is perfectly ok – it actually helps keep your blood pressure and muscle tone in better shape than if you were on complete bedrest. I almost never recommend total bedrest.

Also, I am wondering why such a large time lapse to your next appointment/scan? All research protocol suggest that with your length of cervix getting monitored every other week would be ideal.

I just wanted to get your opinion on my situation anything would help at this point. You have been very informative with other posters.
With my first pregnancy, I had bleeding around the 9th week and was put on bedrest until end 1st trimester. After that the pregnancy was pretty much uneventful until the end where they induced me at 39 weeks because the doctors though she was not growing in the womb.
With this pregnancy, I started feeling Braxton hicks contractions around week 16. At my 23 week check up, I told my doctor that I was still having these contractions and that I had a dull ache about two weeks ago for 2 days and it went away and came back a week later for a day. I was not concerned about the number of contractions, just that I felt them so early. She did a cervix check and said it was closed and also did a ffn test. Later that day, she told me to drop everything and head directly to the hospital because ffn test came back positive. I was admitted after a few contractions showed up on the monitor. I was given steroid shots and give Procardia. At one point during my hospital stay, my heart had raced to 150, doctors don’t know what caused it. I was released two days later. I talked to the doctor and stopped taking procardia as I thought it was giving me insomnia and making my heart race sometimes, and my blood pressure is on the low side, plus I was only having about 3 or 4 contractions a day. (2 days of hospital stay, I lost 3lbs and could not sleep for over a week)
I took the last procardia on May 7 and had about 3 or 4 contractions a day until May 16 at which point they increased to 15, then the next week it would increase to 20, then the next to 25 and now I’m averaging about 30+ sometimes 40+ a day. I was concerned because of the increasing numbers of contractions so I went in to see the doctor, though I had a ultrasound a week ago and cervix showed long and closed. They picked up about 4 contractions in 45 min. She did a cervix check and said it was closed (maybe very slight opened) and thick. I was a bit comforted when I read Heather’s story on your board, except the doctor did a ffn test and it came back positive again. I’m more worried now because though the previous ffn test came back positive, I was not having this many contractions at the time. The doctor told me to go to the hospital and get terbutaline shots, but since I have gestational diabetes (and the bad effects I read it had on mother and baby), I would rather try procardia. I tried10mg procardia and it does seems to be working.
I am really hoping I am one of these people that has tons of contractions, but does not do much, but at the same time I do not want my baby to be born early, I’m currently 29+ weeks. What would you suggest? The whole time after I was discharged I have been on modified bedrest. Thank you.

I do think Procardia is probably the better option for you. Terbutaline does have many more effects on mom and baby, and I would avoid it if possible. Having said that, if the contractions increase overly, and your cervix starts to show shortening, then you may want to get admitted for a day or two and try alternating Procardia and Terbutaline. Again – only, only ,only – if becomes absolutely necessary. Otherwise, titrating the dosage of Procardia should hopefully be enough.

Ffn test being positive is the only slight issue. However, Positive Ffn does not always mean pre-term labor. There is a high degree of correlation between a negative Ffn and not going into PTL, but there are enough instances of false positive with positve Ffn. So, hopefully you may be one of those moms with a positive Ffn but not go into PTL.

With your number of contractions, modified bedrest is a good rule to follow. Along with this, some meditation, deep breathing and relaxation techniques would be of great help, as all of these have a calming effect on musculature. Uterus being a muscle, also reacts well to these techniques. Along with this, having someone pour warm water over your belly for 10 minutes everyday, while you do deep breathing might also help. Granted that the contractions will not completely go away, but it will minimise them for a few hours, which can only be good for both you and the baby.

Hope this helps – if you have any further questions, please feel free to write in.

I am 12 weeks pregnant and my cervix measures 2.9cm is it dangerous i have had 2 miscarriages and one ectopic pregnancy before this baby is very important for me my age is 27 years I am scared if everything goes all right till the end can you please let me know if I need to take some precautions ill do everything to get a healthy child

Yes mam i am taking duphastone 2 each a day folinext & ecosprin & Susten (orally) i had my miscarriages 1 month & a week ahead it were before 1.5 months always also it was same incase of ectopic now I have conceived naturally have done my sonography last week and the baby is normal I am just worried if my cervix which measures 2.9cm would that be a problem?

Dear Dr. Vijaya,
Thank you so much for your response, I’m truly grateful you find the time to answer these queries on top of all your work commitments.
The scan I had was a internal trans vaginal scan and in my previous pregnancy the last scan I had, at 20 weeks, did not show up any cervical shortening, although I am unsure whether in the UK checking cervical length is normal protocol? I feel perhaps my cervix may well have sustained trauma whilst trying to deliver my little boy, maybe causing this problem?
Do you feel it would be advisable for me to request my next scan appointment be brought forward? Having been on bedrest for a week I feel a huge reduction in pelvic pressure and I no longer have a sensation that I can only crudely describe as having a very uncomfortable tampon in place ( sorry for the description!).
I’ve now reached 22weeks today, but that magic 25 weeks still feels along way off!
Many thanks again,
Kate.

Your website is really informative and I have a question for you as well. Last week, I was 21 weeks and 3 days when I had a transvaginal and abdominal ultrasound done. During the transvaginal, they noted that my cervix was 2.7 cm with no funneling. I went back again today, which made me 22 weeks and 2 days today and they found no change in my cervix length. I have another child who is 8 years old but I carried her to full term with no problems. I am scheduled to be seen again next week to do another transvaginal ultrasound. Should there be any specific questions I should be asking my doctor? I also live upstairs in an apartment complex and do quite a bit of walking at work. Please advise as I want to give my baby the best chances possible. Is there any specific milestone that I have trying to reach as well?
Thanks,

Considering the length of your cervix, it certainly makes sense to be monitored at least every 2-3 weeks. Even though it may not be able to prevent further shortening, earlier detection of some of the concomitant issues with shortening, lead to better outcomes for both baby and mother.

I am very glad that your bed rest is physically better – and many times that is the first indication that things are stabilizing internally. Hope this is the same in your case.

Thank you soo much for all of your comments and opinions! First problem is doctor calculates my pregnanacy at 24w based on my last menstrual period. At 16 weeks I went for an ultrasound and the beby was measured at 18w6d. 4 weeks later went for another ultrasound level 2 baby still measuring 2w6d further than my ob’s calculation. So to my ob I am now 24w and to the ultrasound doc I am 26w6d. With that said my cervix in that 4 week time was shorter by 1.5 cm measuring 2.0-2.5. I was put on modified bed rest. 2 days later I started feeling pressure so i went to the hospital where they found I was having contractions. They gave me medicene to stop the contractions and I went home. The following day saw my ob who prescribeb strict bed rest with bathoom priveledges.
I have been experiencing extreme tightness my entire pregnancy on and off with no pain. Since bed rest 2w now I only experience tightness when i am stressed or take too long of a shower. This is my second pregancy. My daughter is now 4. I had no complications with her but do have hpv and have had several leep procedures in the past.
Sorry for the long email. So my questions to you would be. In your opinion is strict bed rest advisable for the rest of my pregnancy in my situation? Would my baby have a good chance now to survive? Is sitting up in bed in a reclined position okay? I’m afraid to lay on my back even when sitting up?
Thank you
Sincerely Jessica

To answer your questions:
1. I would not worry too much about your due date. The more accurate prediction can be arrived at by looking at your early scan (usually done between 8-11th week) or a nuchal scan done between 11-14th week. The most accurate date would be done keeping your LMP EDD and you early scan predicted EDD. The dates start getting really off once you go later into your pregnancy.
2. Once you get to 28 weeks the baby’s chances of survival with least complications get better and better. In the meantime, if you are having too many contractions, an Ffn test can be done. If it comes back positive, steroids can be administered to mature your baby’s lungs. If it comes back negative – we can afford to wait for some more time.
3. 2.0 or 2.5 cms? Were measurements taken at different times, by different people or by different methods? If it is around 2.5 you can be on modified bed rest and continue to be monitored every 2-3 weeks. If it is 2 cms, then you are better off with bed rest with bathroom privileges and some walking around the house. As long as you do not lift anything heavy, do not strain at stools, climb stairs etc. you should be ok. I do not like strict bed rest unless absolutely required, because invariably it leads to pelvic pain, back ache, muscle tone loss etc.
4. I do not like the semi-reclined position. It puts too much pressure on the abdominals when to try to come up to sit from this position. So I would recommend either a much straighter sitting with pillows propped up behind you on your bed/chair, or lying down on your side. In your case, there would be no harm if you sat upright for periods of 20 mins or so, several times a day. Also walking around the house for 5 mins each time, once every 4-6 hours should be just fine. If there is further reduction of cervical length, we can think about stricter bed rest at that time.

i had a leep procedure 1 1/2 yrs ago.. i have 2 children.. 4 and 2 yrs old.. i had no problems with their pregnancies..except when i had my first.. i had problems dialating.. so had a c-section and delivered a 9 lb 3 oz boy.. 2nd baby was only 6 lbs 9 oz girl.. both healthy and full term.

i have read and heard that a leep can increase your risk for pre term labor.. my dr did a dating ultrasound when i was 11 weeks because i’d had a miscarriage at 5 weeks the month before. and found out i was pregnant before i got a period after the miscarriage.

my dr checked my cervix length because of my surgery..and it measured 3.6 cm.. does that mean i could have issues with pre term labor or is that a good number? i never had problems pre term labor with my other 2.. my dr does have me on progesterone suppositories because of the miscarriage.. i was approx 5 weeks 3 days when i miscarried. .. otherwise everything is fine.. i’m just concerned about my cervix now..

There is really o magic number that is “good” . 3.6 cms is reasonable – we would just have to wait and watch are your subsequent monthly visits. If there is remarkable shortening, with your LEEP history, it may be worthwhile considering a cerclage – but only if it shortens too much. I am certainly not a proponent of cerclage, but sometimes it provides good results if done early enough – between 11-16 weeks. And, it would allow you to remain active, considering you have 2 other children. However, it does have the downside of sometimes causing preterm labor. So, you would have to discuss the merits with your OB.

As per your current situation, i would just as soon wait and watch as to how your cerivix does at your next scheduled check up.

Thank you for your reply. My due date concerns were based around being anxious for the 28w goal mark.

2.4 was my cervical measurement 2.5 weeks ago. I do not have a bathroom on the first floor so my only option is to stay in bed. I go to my next appointment in 5 days. He’ll do another measurement then. Sometimes the measurements are taken just by an internal exam which is most of the time. I have only had two measurements with ultrasound.

Bladder infection has to be cleared out completely; so taking antibiotics becomes a must. If the infection is not cleared out well, it can recur, and recurrent infections can irritate the uterus along with irritating the bladder. This is something we do not want.

Just wanted to let you know that I am continuing with the antibiotics and at the last appointment on Monday, my cervix length was 4.2 because I worked only 2 days last week. I have another appointment on Monday coming to check and see how work is affecting my cervix.

My appointment was yesterday. Everything is the same. Which doc says is good. He said to continue what I’m doing. Which is: not using the stairs(maybe 2x a week) laying in bed, getting up for showers and bathroom. Since I spoke to you last I have been allowing myself to sit up and eat for 20 min at a time. Which has helped with the acid reflux. I have also been allowing myself a 5 min walk around to set my bed or look out the window. Evry 4-6 hours as you suggested.

I asked the doctor if my cervix had gotten longer? In hopes of less restriction. He said resting has nothing to do with my cervix getting longer. Just stronger. Because of my past leep procedures and preganancy it will remain the same length.

My confusion comes into play because I had these procedures before my daughter. I had absolutely no problem carrying her. They monitered my cervix all the time but never was I on bed rest. Why is it different with this baby? Could it be that baby is bigger? I was also assuming that ubtil 20w I was cleaning residentially 3 houses a day. Which I believe led to a weakened body. I say to myself now that I’m not cleaning my body should be fine with menial tasks. At least i’m not cleaning 3 houses a day.

Yes, usually cervix does not grow longer – what we are trying to do by taking pressure off the weakened cervix, is to hopefully try and minimize further premature shortening and dilation. Having said that, we have had increased cervical lengths reported with bed rest. This is usually due to difference in measurement techniques, the skill of the sonographer, fullness of bladder, etc.

Unfortunately (or fortunately!) you cannot compare pregnancies. I also do not think that physical activity has anything to do with it. Either your cervix is strong, or it is not. If it is strong, any amount of activity (except heavy lifting, which is anyway to be avoided in pregnancy)) will not cause any issues. If it is weak, then all precautions need to be taken. There is no way you could have done anything different without having any symptoms.

I wrote you May 3rd. I wanted to come back to you since I found your answer very helpful and give you an update on my condition.

I’m now 32 weeks pregnant and back in Switzerland. We were living in China before. I have a doctor here which measures my cervix every two weeks and they do it vaginaly not abdominal. So with my last appointment my cervix was 2.5cm and soft – but it has been soft since they checked it around 25 weeks and it was soft with my first child. The doctor is not too concerned about the 2,5cm but about the softness a little bit. He gave me gynipral medication for my uterine irritability – I have contractions at least every 10 minutes and he gave me utogestan (progesterone) to insert in my vagina twice a day. Other than that he tells me to take it easy but I’m not on bed rest.

Do you think this is enough or should I be on bed rest more seriously?

I would not be too concerned with the length – since you have already touched 32+ weeks. As long as you are being careful with physical activities, and getting checked regularly, I think your OB and you are both doing all you can.

Thank you for replying last time. Well it has been over two weeks since the positive ffn test and I am 31 weeks now. My contractions are now about 35+ a day sometimes 5/6 per hour at night. I also started lite spotting again which I attributed to my polyp. At my weekly visit, the doctor initial check my cervix and said it was closed, but said he did not see any polyp and said is concerned about the spoting. He said then to wait for a contraction and he will do another cervix check. When he checked me duing a contraction, he pressed on my belly hard and said now I am a finger dialiated. He wanted me to go to the hospital and get the terbutaline pump because of this, the spotting since he did not see any polyp and the two positive ffn tests I had in the past. I refused. I hope I made the right decision. I am also a bit worried that his cervix check during the contraction may have cause something. I am now on 20mg Procardia every 6 hours, but if it does not work, I feel I will be pressured into taking the terbutaline pump, something I really want to avoid. Thank you and of course your opinion is greatly appreciated.

Sorry it took me longer than usual to reply. My internet connection has been giving me trouble.

Checking for cervical status during a contraction with fundal pressure (pressing on the abdomen) is probably the best way to determine how dilated your cervix is. However, it will not cause any deterioration of your physical condition.

Considering that you are having so many contractions, and positive Ffn, it makes sense to take Terbutaline if the condition worsens. I do not recommend Terbutaline to anyone lightly because of its extensively documented maternal-fetal side-effects. However, it the contractions worsen, because of the status of your cervix, it would perhaps be effective to alternate between Procarida and Terbutaline and see what effect this has. This would probably expose you and baby to less Terbutaline than if you were on a pump.

Hang in there – next milestone would be 34 and then 37 weeks, after which you can stop all meds and let your body and baby take it from there!

In the meantime, try music, meditation, relaxation and warm showers to help manage the contractions.

Thank you for your previous reply. I have been tis morning for another Vaginal ultrasound scan, which showed that I now have a closed cervical length of 8mm, but internal O’s open length 24mm and open 1cm. I am 23 weeks and 4 days at present.
The doctor has advised that I return on monday, when I will be 24 weeks, for steroid shots to develop the babies lungs. Do you think this is this premature or advisable at this stage? I asked the Doctor whether a FFn test would be appropriate, but he feels that this is unnecessary, also he didn’t advise that I would be suitable for any progesterone pessaries or injections, is this something that you would agree with?
I am also due to have another scan next week for further monitoring of my cervical length.
The good news is that the baby is doing well and seems big for his gestation and also there’s plenty of fluid in the amniotic sac.
I would be most grateful for any advice you can give me as to my situation,
Many Thanks,
Kate

I’ve had a further scan at 24 weeks 4 days which showed further shortening, the cervix is now 5mm and the funneling is pretty much the same. My Doctor says she feels there is no point doing further scans, as this won’t change anything and will just increase risk of infection. I feel a little nervous knowing that I will no longer have an idea of what’s happening to the cervix, but understand that there’s nothing that can be done.
I’ve had the steriod injections and the Doctor says there’s nothing more to be done except hope the baby stays put. She also doesn’t feel that bedrest will help the outcome, but I’m still remaining on bedrest.
In your opinion is there anything else that could bedone? Many thanks for your advice and time, Kate

At 5 mm length, probably everything that we do to try and protect your pregnancy will be with empirical evidence. Yes, bed rest may not help according to hard research evidence – but, still I would advise it because many a time that has made the difference clinically.

I agree with your OB – at this stage, there is no point in doing vaginal ultrasounds. How often is she calling you for check ups? Are there any contractions? If not, this is a good sign for now. However, ensure that you monitor whether there is any trickling or leaking of fluid from your vagina. Some moms with your condition do not get any contractions, but land up with painless dilation and breaking of bag of waters.

Kate, you are doing all that you can. Next milestone – 27 weeks.

Keep up your spirits, and if there is anything else that I can do, please feel free to write.

hi hope you remember me well i made it im 35 weeks pregnant around two weeks before this i was in the hospital for pre term labor and was stopped but the next i had trouble breathing i was told i had fluid around my heart and lungs was treated for neumonia and pulmonary embolism but felt alot better so was send home, now i was told they had to remove the cerclage because i was to thinned out. and now im 3cm dilated, 80% effaced, and at -1, i lost my mucus plug already as well and i’ve been having contractions everyday but there not regular, im just wondering how much longer do you think this will take. also i started having this pain i think my heart like a sharp stabbing pain whenever i move or do anything really and my left leg is very swollen and one of my veins looks kind of swollen and like a red spot should i be conerned about this and if it is something serious do you think any complications will arise during labor. just loking for your honest opinion thanks again so much

Sorry for not responding – my internet has been down. Hope all is well with you, or perhaps you have already gone into active labor and delivered?? If not, with so much dilation and effacement and baby’s current position, it should happen soon enough.

I am very concerned about your chest pain, as well as your swollen leg and spot. With your history of pneumonia, and embolism, I am hoping that it is not Deep Vein Thrombosis – which is basically a clot in one of the veins of the leg. This can become really dangerous if it gets dislodged, and has the potential to escalate to a full-blown emergency.

I just completed a pap exam. When the doctor started he said that he had to re-due something because my cervix was short. He didn’t tell me there was any issues or problems with this and other then just making the statement he didn’t bring it back up again. I had no idea what it mean. So of course I asked my mom. She explained that she had the something and that it meant that the cervix is was just a further back. I am wondering is this will cause any problems getting pregnant? Im not sure if this is even a issue sense he didnt speak with me about it. Do I have anything to worry about?
Thanks you.

I cannot really give you an opinion based on what you have written. I would advise you to ask your doctor exactly what his findings were, and ask him to write it down in your case sheet. In this way, you will have a record for yourself, which will be good for future reference.

Having said that, even if your cervix is short, that should not cause issues with conception. Only, after you get pregnant you will need to be monitored very closely.

Do write in once you get to know exactly what your doctor found during his examination.

Dear Dr. Vijaya,
Thank you once again for your advice, opinion and your encouragement, It is so hugely appreciated.
The Doctor didn’t want to see me again until 32 weeks, which I thought was too long! so I requested to be seen again in 3 weeks when I’ll be nearly 28 weeks, just for my piece of mind really! I was having some tightennings across the bump a few weeks ago, but I’ve not experienced that for nearly a week which I’m pleased about. The babies kicking away and apparantly there’s plenty of fluid around him, which is really great news.
I’m sticking to bedrest and keeping my fingers crossed, many, many thanks again, Kate.

Dear Mam,
My cervix measures 2.9cm
Tablets prescribed
Duphastone 2 each a day
Folinext
Ecosprin
Susten ( Orally in the night)
My (2) misscarriages were before 2months every time
I had an ectopic that too was 1.5 months pregnancy
The doctor has changed Duphastone from 2 to one last week onwards
My triple marker test is scheduled on 11th July & the next appoitment with doctor is on 18th July on 18th ill complete 4th month & start with 5th one
Also my tummy is not visible so far I hope that is normal

I’m so glad I found your website. This forum has been extremely insightful and educational. I am 27 years old and currently 21 weeks pregnant with my first child. I regret that I had an elective first trimester abortion when I was 18. Other than that, I do not have any risk factors for cervical insufficiency. At my 19 week ultrasound, my cervix measured 3.2 cm. From what I have read, this seems to be borderline normal. However, neither the ultrasound technician nor the doctor made any comment about it. Thus, I assume they were not concerned. However, the 19 week ultrasound was the only ultrasound I will have, so I can’t stop worrying that my cervix may shorten and cause me to lose my baby. A lot of the worry is due to my previous abortion. What is your opinion about the 3.2 cm length and any effect the previous termination would have on my cervix now?

3.2 cm is within normal range. No, you do not need more monitoring at this point. And no, your previous elective abortion should not have any relevant effect on your cervical length. Unlike LEEP procedures and cone biopsies which directly affect the cervix, an abortion does not.

At 14 weeks I had a transvaginal ultrasound and my cervix was measured to be 4.2 cms. Today, I had my 20 week scan and my cervix has shortened to 3cms. The scan was done by a tech and won’t be read for another week.
But I felt concerned and so I called the midwife that I seen a few days ago for a routine visit. She said to come in tomorrow to get a vaginal test done to see if I had some bacteria and also a urine analysis. She says that a UTI or a vaginal infection could cause the cervical shortening.

I’ve also been experiencing some Braxton Hicks on a regular basis starting at 18 weeks. Last night I had one that lasted a solid 30 min before letting up(my uterus didn’t relax for a full 30 min). This is my 3rd pregnancy and I’ve NEVER experienced any BH with any previous pregnancies and no preterm labor(I’ve actually had 3 Csections).

The midwife said if the Doc is concerned they might bring me back in in 4 weeks to do another U/S. That to me just seems like a really long time! We are military and we get seen every 6 weeks until 30 weeks. I’m just VERY concerned that my cervical shortening combined with the BHs and my past history (of no BH or labor) isn’t being taken seriously.

What are you thoughts and if you were my Doctor, how would approach my care?

The length of the cervix does not concern me too much at this point. However, with your uterine irritability, it would be prudent to get checked once within the next week or so. Also, has urine C/S been done – although UTI does not cause cervical shortening, it could lead to uterine irritability.

Just out of curiosity, what were the reasons surrounding your previous C-Sections?

I am currently at 16 weeks with Triplets. 2 weeks ago my cervix was 4.2cm. Today, it is 2.1cm. My doctor is scheduling a cerclage right away along with bedrest for the remainder of my pregnancy. I had a miscarriage at 8 weeks approx. 1.5 years ago. Is this the right thing to do and is there anything else you can reccommend I do to prolong my pregnancy?

Sorry I could not respond earlier. If your doctor did put in the cerclage, it was absolutely the correct thing to do. With triplets, and the sharp decrease in cervical length, this would be the best course of action, along with moderate bed rest.

Dear Dr. Vijaya Krishnan,
My cervix measured at 3.2cm or 32mm at 18 weeks. My doctor is recommended another ultrasound because she says that’s on the short side. I would like to avoid any unnecessary ultrasounds and it appears that only a cervix under 30mm should prompt any concern. Your input is greatly appreciated.

Yes, technically a cervical length under 3 cm needs monitoring. However, a repeat ultrasound would be recommended to see if there is any progressive shortening. If the length remains the same, you need not be repeatedly monitored thereafter.

Having said that, please ensure that your bladder is full (drink at least a liter of water about half hour before the ultrasound and don’t use the bathroom). the fuller the bladder, the cervix gets pushed up and can be better visualized and measured accurately.

I am writing on behalf of a good friend of mine. She is currently at 21w2d with her third pregnancy. Her first pregnancy, she delivered a singleton baby girl at 29 weeks; with her second, she delivered twin boys at 23w3d, two weeks after a cerclage was placed due to cervical shortening. (Sadly, the twins were not able to overcome the complications of their prematurity and did not survive.) After her second pregnancy, she was diagnosed with APA as well as a homozygous MTHFR mutuation.

With this third pregnancy, they are being very aggressive and proactive about monitoring her; she is on lovenox for her thrombophilias as well as progesterone supplementation. At 19 weeks her cervix measured 3.9 cm; at 20 weeks it measured 3.6 cm; at 21 weeks it measured 2.7-3.0 cm depending on whether she was contracting or not. (She has an irritable uterus as well.) Any amount of activity at all sets her contractions off, and she has now been admitted to the hospital — probably until she delivers.

After what happened with her twins, she is reluctant to get another cerclage, and from what I read here, it may be too late to be advisable anyway. I know that everything is being done to sustain her pregnancy, but I wanted to ask you if you think these measurements add up to the picture of someone who has any hope of making it to 28 weeks or even 24. She is very frightened, and so are we all as her friends.

Thank you so much for the service you do here. It is a blessing to frightened women.

First of all, I am happy to be able to help out in any way at all. My hope is to be able to provide good research based information, and a forum where moms can take heart and learn from each others’ experiences.

As re: your friend, with her previous history of one preterm birth and one second-trimester loss, I just have to wonder why she was not put on preventative cerclage between the 11th-13th week? Research shows that preventative cerclage combined with good prenatal care and rest, can indeed lead to better outcomes in mothers who have had such a history.

For now, monitoring would be he way to go. This along with appropriate medications to handle her irritable uterus and decreased activity levels (her cervical length is borderline normal) would be the way to go. Also, she can refer to Heather’s posts (and my responses) on this forum – it will give all of you some encouragement.

Hope this helps – please feel free to write in with any queries or concerns

She didn’t have a cerclage because it would require being off her lovenox for a week, and the doctors were balancing the risk of IC vs. the risk of clotting in her placenta.

I am pleased to report that as of tomorrow, she will be at 25 weeks! Her cervix is holding steady at 3 cm despite contractions, and her doctor has strong hopes for her seeing the good side of 28 weeks or even 32. I know 25 weeks is not a good time to have a baby, but compared to 21, it seems like night and day.

i am 32 weeks of pregnant now doc says preterm labour and given two injection of{ diprofos im }every 12 hours on 19.7.2009 she said you have to admit in hospital and i went to hospital they have taken non stress test and said go to home i am not having pain or anyother syptom my doc said that baby head is very down now what to do pls help me

With non-stress test being ok, and no further pain or symptoms, if the cervix is holding its own, it would be best to be on bed rest, and go forward week by week. Once you cross the 34 and then the 36th week mark, then you and baby would be on the home stretch – and it would not matter when your labor starts.

Since you last wrote on July 20th, I hope you are still hanging in there – this means you would have already crossed the 34th week mark.

Dear Dr. Vijaya,
I thought I’d write and let you know that I delivered at 27 week gestation, a little boy who weighed 2lb 8 oz and is now making good progress on the NICU.
I’d lost my mucus plug 10 days prior and the morning I gave birth was having incresed Braxton hicks contractions. I luckily decided to get checked out after the BHCx moved to low down and were spaced at regular 5 minute intervals, although they weren’t that uncomfortable. Whilst being monitored they started to get intense and more uncomfortable and I fully dilated and gave birth within 1 and a half hours, luckily I’d had the steriod shots at 24 weeks and with his great birth weight I’m really hopefull we’ll bring him home in a few months.
I’d just like to say a huge thank you for the time you took to reply to my questions, you probably have no idea how much your responses are appreciated, but you certainly make the world a better place and I’m truly grateful that you’re helping people like me in our hour of need.
Many thanks again, Kate

First of all CONGRATULATIONS! I hope that both you and baby are doing well, and that your baby is getting stronger each day.

I am so glad that you were extremely vigilant and aware of what your body was doing – I always tell moms that being aware and responding to gut feeling, is as much important as good prenatal care. Your awareness resulted in getting the best possible care for both you and your baby.

As always, I am humbled and honored to be part of so many womens’ journey (yes, it is turbulent at times) to motherhood.

Thanks for writing in – please feel free to remain in touch, either through this blog or through my e-mail – vsakotai at yahoo dot com

This is a great ongoing thread with a lot of amazing information. I’ve sat here (while on bedrest lol) looking for something that could relate to my situation. So here goes.

I pray you can provide me with some advise Dr. Vijaya.

I have a history of scar tissue collecting on my cervix. Im not sure if this is pertinent but it is normal for me. I have had the scar tissue tested annually since I was 14 years old. I have PCOS and am Insullin Resistant.

Prior to becoming pregnant, I’d lost 150#’s in the process of my weight loss, my gall bladder developed stones. I had had several minor attacks prior to becoming pregnant.

After becoming pregnant, I’d become Hypermesis. I was treated with Zofron. Unfortunatelly my Hyperemesis has continued on throughout my pregnancy in addition to a weakened immune system that has plagued me with chronic infections.

July 5th I was 26 weeks pregnant. I went into the hospital after a 24 hours of serious emesis. My gallbladder had become inflammed and had to be removed.

July 7th I underwent surgery. July 9th, It was found that the baby was suffering from small abdominal circumference. My OBGYN assured me it was due to the chronic emesis and dehydration. Our baby would recover and begin gaining weight. My cervix was measured short at 2.2 cm. The doctor again was sure this too would fix itself with recovery time from the surgery.

The day of my surgery I went into labor from 7pm until 7 am. My labor was stopped with several injections of Tribudiline. my contractions at the height of the 12 hour event were 2-4 minutes apart.

As a precaution; I’ve been sent to a Perinatal specialist today he measured again and the baby has gained 1 lb since my last ultrasound. He now weighs 2.5 lbs. I’m now 28 weeks pregnant.

The baby is very very active. Unfortunately………my cervix has degrated to 1.67cm and I’m now funneling.

I’ve been placed on complete bedrest. I now must see my doctor every 4 days for stress tests and continue to take Procardia every 6 hours. I’ve been told there is nothing we can do at this point except help the baby gain weight. I’ve been told I will follow up with the specialist in 2 weeks, If he feels the baby is not growing properly or is continued to be restricted, he’s going to deliver the baby.

Monday they are going to be starting the shots to develop our baby’s lungs.

The doctor has told me that there is a greater than 70% chance at this stage that I will deliver in the next 2-4 weeks.

I asked him if we can do anything to prevent the baby being born to early. He told me that this is not a preventative situation…… its a rescue mission.

I need hope right now. I don’t want to see my first child tube fed or in pain of any kind.

First of all – what a great job you are doing, just hanging in there with all the ups and downs of your pregnancy! I cannot even begin to imagine what you must be going through.

It looks like your OB is doing all he can. Every week that the baby can stay put, will help him/her gain weight and improve reflexes. 28 weeks is the first milestone, and the next 32 weeks. Since you might have already had the shots to mature the baby’s lungs, the only thing you can now do is lots of rest, relaxation, deep breathing and taking care of your nutrition. I understand that you may be on a specialized diet due to your surgery, but if you stick to a good diet within those restrictions, your baby would still hopefully show growth, and may not require to be rushed into being born.

Please feel free to write back – All good wishes to you and your baby
Dr.Vijaya

I’ve now made it to 32 weeks. Still on bedrest… Still taking Procardia. Still doing NSTs 2x a week. The baby is moving great, and i’m not having any recorded contractions. I have another Ultrasound; fetal assessment test to be done on 8/25. The baby is now measuring 6 days small for gestation, but the bedrest has definitely helped in his putting weight on. PostOp he was measuring 9 days small.
They have postponed developing his lungs because my cervix has remained “unchanged” (its now at 1.7).
The umbilical cord has recovered back to 3.11 since the surgery. Because of his weight the objective is to keep me pregnant as long as possible. Dealing with hyperemesis and infections has taken a toll on his development.
The next milestone is 34 weeks. I’m hoping tuesday when i see the Perinatal Doctor they will have good news in that my baby boy is over 3lbs.

Hello Dr. Vijaya,
Hope you are doing great
I had mailed you the details of medicine in my last post
Now the medicines have changed to
2 spoons calcium syrup after breakfast
1 iron tablet & 1 folic acid tabled in the afternoon after lunch
1 ecosprin after dinner + 2 spoons calcium syrup
My triple marker test results are normal
Yesterday 18.5 weeks USG was done and the cervix now measures 3.5cm
Is this normal earlier it was 2.9cm
Can cervix length increase?

Sorry that I was not able to respond earlier. Over the past 3 weeks we have had so many deliveries happening at our Birthing Center, that I have felt at times that I live there rater than at home!

The meds overall look ok. However, I am not sure of why the calcium is being split into two doses. Also, Iron usually interferes with the absorption of calcium.

I usually recommend that moms take Iron with Orange Juice or Sweet lime juice (since iron needs vitamin C for absorption) just 20 mins to half hour before breakfast. Similarly, I recommend that Calcium be taken at night – before bedtime, since calcium is absorbed best at night. Folic acid can be taken at any time. Ecosporin is ok the way you are taking it. Please ensure with your OB if you really need to take it, and for how long. I am finding more and more that Ecosporin is being prescribed like a vitamin – and really there are no studies indicating whether it is needed at all.

Cervical length measurements look great. The difference in measurements may be related to how full your bladder was during each USG. Were both measurements done vaginally or abdominally?

As of now, you can continue to be monitored every 2-3 weeks – no other precaution is required.

Hi Dr.
Its Tera from way back, I hope you remember me
Just want to let you know that I delivered my baby boy on the 23rd. we made it to 35 weeks and 1 day
cerclage held up great but had to be removed as contractions at that point were not stopped
keep your heads up ladies
i swear my bedrest, cerclage and p17 shots helped that was my recipe
good luck to all
Tera

This reply is for all of you brave moms who are going through such an uncertain and anxious phase in your respective pregnancies. Hang in there – write in to blogs and support groups such as this – follow your precautions – be well-informed about all your options and choices. More often than not, you will pull through.

I’m 25 y/o & have had 2 Lletz (Large Excision Loop Procedures), one at 22 the other only 3 months ago, for Cin 3 cervical cells. My doctors were always quite honest telling me it may be hard for me to conceive & difficult to carry to full term. I’m now 11w2d pregnant (miracle)! I had a scan 2 weeks ago & my cervix measured 2.7cms. I had another scan 2 days ago & it was still the same. What do you think my chances of having a healthy, full term pregnancy are? I’m worried as I HAVE to work as much as possible before the labour & am wondering if doctor’s will advise a cerclage or bed rest & if so, when? My partner & I would just like to know what we’re in for… & our doctors aren’t being all that helpful.

Thank you for your advice, this site has already been a big eye opener!

Yes, LEEP procedures do predispose to shortened cervix during pregnancy. However, for now your cervix seems to be holding fine. Having said that, 11 weeks is too early to tell how the cervix will be when the weight of the uterus is more – so perhaps a better indicator would be around the 18th week or so.

I am not aware of any studies which suggest a preventative cerclage (and efficacy of the same) for moms with previous LEEP procedures. But, I know of OBs who will put in a cerclage just to give the mom a better chance of making it further in their pregnancy without being on bedrest.

2.7 cm is borderline length. And, given your previous history, it may be worth it for you to explore the option of cerclage with your OB. Yes, cerclage can give rise to uterine irritability, but the earlier it is done (now being the perfect time for you), the lesser the uterine irritation. So, you may want to look into this, and look for a doctor who can sit down with you and lead you with true informed decision-making.

Other than this, you do not need any precautions at this stage. If cerclage is not done, you will need to be monitored every 2 weeks.

Dear Dr Vijaya
I would just like your advice on my recent cervix measurements.
I am currently 22 weeks pregnant with twins.
8 weeks ago it measured 43 mm
5 weeks measured 35 mm
2 weeks measured 37mm
yesterday it was 29mm
My doctor just said everything was fine and see you in 2 weeks. It was only when I came home and looked on the interned I saw it was on the low side. I am still working full time and was wondering if I should now stop.
I lost a baby to pprom 2 years ago at 18 weeks.
Kind regards
Sue x

Yes, 2.9 cm is borderline. But, all research indicates that as long as you are monitored every 2 weeks, you should be fine. No restrictions on physical activity is needed at this point. As you are carrying twins, this length is actually reasonable, and unless there is a marked trend to shortening over the coming weeks, you can still continue to work.

Is it the same OB that you were consulting when you were pregnant the first time? PPROM at 18 weeks – I am wondering if they addressed needs for cerclage earlier in your pregnancy? Just a thought. However, this does not alter your current plan of care.

I just wanted to say that I think every woman and every pregnancy is completely different. I am at home now at 28 and 1/2 weeks on a terbutaline pump and strict bedrest. My Cervix went from measuring at 2cm to 8 mm in a week and 2 days and those days were spent in the hospital 2 of them on a magnesium sulfate drip. They decided to keep me there until 28 weeks and started me on my terbutaline pump while I was in there to make sure it was stopping contractions. I came into the hospital have a contraction every 2-3 minutes. Now I have like 1 or 2 an hour maybe. My doctor sent me home on 3 conditions, one I had to be within 30 miles from the hospital (with a NICU), I have to have someone around 24/7 incase I do need to go right away and he had to feel I was knowledgeable enough to know when I need to get my butt back in there. No doctor out of quite a few I have seen can give me an answer as to how early I will deliver and I don’t expect them to. It could be tomorrow or it could be weeks from now all I know is you have to just do what you can and have hope. My first born was born at 33 weeks and you would not know it today. They really have made some incredible advancements in the NICU so try not to worry, but don’t go overdoing it or nothing. Good luck to everyone on here.

I wrote to you back on June 17th inquiring your opinion about bedrest and my cervical length. I am currently still on bed rest. Even with bed rest I ended going into pre-term labor a week ago. I spent 4 days in L&D. My cervix went from 2.5cm to 80% effaced and 1.5cm dilated in one week. I had an exam the Monday prior to the labor. The controversy over my due date was settled after a last minute ultrasound. They were able to stop the labor with Procardia and fluids. They did take a FFN test that was negative and administered steroid shots. Sent me home Monday morning and tuesday night I began to have contractions again. They say I have an irritable uterus now and sent me home with a one week prescription of Procardia every 6 hours. The results of the ultrasound were great the baby is 2w6d further along. So I am now 33w3d. Just an update.

Now my questions to you are. How come my weak cervix just dilated on its own with me adhereing to the strict bed rest rules at home? Rest or not the cervix will dilate? What about his Procardia? Is it safe? It seems to stop the irritability. Well lessen it anyway. If my doctor takes me off the procardia will I go into labor? Does the procardia stop my cervix from dilating? Everyone has different opinions about it. I’d like to know what yours is. Well I guess thats it and definetely being at 33w3d is a huge accomplishment knowing the last we talked I was at 22w and afraid that I wasn’t going to make it to 28w!

Yes, sometimes, rest or not the cervix will dilate. All research shows us is that, women on bed rest usually make it further along, than those who are not on rest.

Procardia is safer than some of the other alternatives – however, each and every medicine has some side-effects and every one of them crosses over to the baby. But, you just have to weigh the pros and the cons – at this point stopping your uterine irritability is the most important thing. Procardia, will not stop your cervix from dilating. It will decrease your contractions, and this along with bed rest, will lessen the pressure of your baby’s head against your cervix (which is what causes the cervix to thin out and dilate further). Your doctor can probably lessen the dosage of Procardia, if the irritability becomes markedly reduced. Otherwise, you can stop it once you hit week 37.

You have crossed some of the more important milestones in your pregnancy – so now, each day that the baby stays put, he/she is gaining weight, immunities and is more ready for life outside the womb.

Dear Dr. Vijaya Krishnan,
Thank you for your reply. I appreciate your help. To clarify, my cervical length was 3.2 at 18 weeks. It was not under 3.0. Does that change your response or do you recommend the same? I do not have any other risk factors that I am aware of. I am now in my 28th week.
Thanks again,
Monica

Thanks for your reply
I can’t explain how relaxed I felt after receiving a reply from you
There are a couple of expecting women in my company have referred them this link so as to get their doubts clarified
Your suggestions really help
To be more precise on medicines
I am taking
2 spoons syrup Macalvit – after breakfast
After lunch – Folinext D 1 tablet & Ferium XT – 1 tablet
Bedtime Ecosprin75 + 2 spoons syrup again Macalvit
The first time my USG was done both vaginally & abdominally
This time it was done abdominally
Ill speak to my doctor about the timings of medicine as suggested by you
Also Dr. what precautions should I take so as to ensure that my delivery is normal & not cesarean

1. Educate yourself – good antenatal Lamaze programs are one way that you can get good all round information about the power of natural childbirth.

2. Surround yourself with positive people who believe in th power of natural childbirth.

3. Ensure that your OB and your hospital follow Lamaze and WHO recommendations for labor and delivery. Check out http://www.lamaze.org for “6 practices for a safe birth” and all the website links that we have provided to the right- hand side of our blog.

4. Do your antenatal exercises; these help you to remain flexible, and help in easier passage of the baby down the birth canal during labor and delivery.

5. Finally – maintain good nutrition through out, as well as walk everyday.

I just wanted to come back to join the good news – I delivered a healthy daughter on Aug. 15th in week 39. We are really happy and all the hard times during the pregnancy were worth it. Thanks to your good advise I didn’t lose hope that everything can turn out well.

Wow, what a journey you had – literally (from China to Switzerland) and figuratively!

Thank you for coming back and updating us – many, many moms with conditions similar to what you went through in your pregnancy, will hopefully gain inner strength and confidence to help them in their journey.

Great to know you have made it to 32 weeks – and that your baby is slowly gaining weight. With no signs of recorded contractions, good NSTs and the cervical length being stable, it makes sense to hold off on developing the baby’s lungs. Research recommendations suggest that it is best to give the shots only if there is imminent danger of premature delivery. The shots work only for 5-7 days once administered, and there is no advantage of repeat doses – in fact repeat doses are not recommended. So, your OB is following good clinical protocols.

Keep up your nutrition and hydration, and try to do some small ankle/foot exercises, and arm exercises to keep up some amount of muscle tone as well as to promote circulation and to regulate blood pressure to some extent.

I write on behalf of my wife Kalpana; she had her Cervical Encirclage done in Chennai on 1st August when she was 28 weeks pregnant, she is nearing 32 weeks now and we would like to request your opinion on air travel of 4 hours betweeen Chennai and Dubai; I plan to put her on wheelchair assistance at both ends of her travel and also plan to fly her on an aircraft that has flat beds so she can lie down most of the time.

Cerclage being done at 28 weeks – what was the reason for it to be done this late in your wife’s pregnancy? What was the length of the cervix when it was done? Was there any funneling? Were there preterm contractions or uterine irritation at that time, or since the cerclage placement?

If you can give me a little more background information, I’ll be able to help you out better.

I am currently 25 weeks 4 days pregnant.. had a cerclage placed in at 13 weeks. Since the last 3 weeks, I have been going on a weekly basis for a transvaginal ultrasound with cervical lengths of 3cm, 2.86cm and 2.95 cm. Today again I went for my T.V u/s.. the nurse gave me a measurement of 2.34cms but when my perianatologist met me, looking at the u/s pictures, she said as per, her the measurements were still at around 2.8cms. She said, the nurse didnot measure it accurately.
I am totally confused. Is that possible for her to see such a difference by just looking at the picture.
I have been put on a moderate bedrest… allowed to sit in a reclined position on the couch, get up for bathroom visits and a quick shower. I am also taking weekly shots of progesterone. This time, she has asked me to come in for a check-up in 2 weeks instead of 1.
I hope, everything sounds normal to you.. and do you think, i should be on a stricter ber rest…???

Difference in measurements is very possible at time of ultrasound, depending upon various factors including the skill of the sonographer. However, once it is done, the perinatologist would have to go by the printed numbers on the record/scan. So, I am not sure re: the difference that she saw – you could ask her to point out where she is seeing the difference in measurements.

With the length of cervix that you have currently, it would be okay to go about your daily routine, especially since you have a cerclage in. The whole purpose of doing a cerclage would be negated, if you have to remain on modified bed rest. In any case, I am not sure why cerclage was put in the first place, since your cervical measurements seem to be in the borderline range?

I am not a big fan of the recliner – when you get up from this, you tend to put a lot more pressure on the abdomen, which you should be avoiding right now.

Thanks for your reply.
Well !! The cerclage was put in coz’ of my history. I lost my first son on 1st Dec 2008 at 19.2 weeks.. after which I was diagnosed with CI.
About the measurements, I will be meeting my peri in 2 weeks now.. just hoping that everything remains stable till then. This time, when I asked the peri as to how she saw a different measurement, she said that when she saw the pics.. she thought that the sonographer missed a little part of the cervix.. I want to believe her.. but I am just scared.

If reclining position is not the best option.. what do you think is the best way to relax.. ??

There should not be any issues as far as her cerclage is concerned, especially if there has been no uterine irritability since the cerclage. However, in general, ACOG recommendation is that pregnant women not fly past their 28th week. And, I follow the same guideline in recommending travel to my pregnant moms, no matter how short the flight is.

Perhaps by the time you read this, your wife may be safely in Dubai – if this is so, great! Just thought I would answer anyway.

Hi Dr.,
Thank you for doing this blog…I know others have found answers and interaction they ‘ve been seeking for a long time. I have a question. I have had to pregnancies that ended in elctive therapeutic abortions…with no apparent complication in 2002 and 2005.
Last year I had a PROM and spontaneaous pre-term birth of my son at 23 wks 4 days. He tried to with all his might but did not survive and after 17days of fighting had to let him go. This was in Jun/Jul of 2008. I got pregnant again in January 2009, I then had a miscarriage when I was 8 wks along. I am now 20 wks pregnant. When I hit the 18 wk mark I had a couple days with some strange twinging near my cervix…I called my Dr who suggested I go in to the hospital traige for an assessment…given my passed. I went…everything was fine as far as their eye could see. The Dr that I seen at the hospital where I will be delivering suggested that I come in for an assessment every 2 weeks until I get to 24 weeks and then they will probably consider corticosteroid therapy to “be on the safe side”. They never did find a defenite reason for my previous PROM or pre-term birth. I am concerned though…as when I went in for my assessment at 18 weeks…they measured my cervix at 3.9cm…it was good to hear. When I went in this morning for my 20 wk follow up…they measured my cervix at 2.9 cm. They said it was nothing to worry about and that the cervix was “dynamic” and i’ts completely normal for it change at this stage of pregnancy. I can’t but be somewhat worried. What if this is the onset of another pre term disaster? I will be back for another assessment in 2 weeks…at my 22 week mark. So they are keeping an eye on me. What do you think about what has or is happening?
Thank you so much and congratulations on your great wisdom and work.

Hello Dr,
I patiently await your reply. In the meantime I wanted to let you know that I went in to get another measurement today. he news was not so good….they advised my cervix has again shortened…now measuring at 1.5-1.7 cm. They have given me a prescription for progesterone which I will be inserting 200mg each evening at bedtime starting tonight. I will go back for another measurement and assessment in 5 days. And if my cervix has still decided to shorten they will discuss cerclage at that time. I am so scared. I asked them about any restrictions I had and all they said was no intercourse. I am concerned as I asked about rest, and they said to just continue on as normal as they said that bedrest is not shown to reduce what is inevitable. They said what ever is going to happen will happen whether on bedrest or not. I am scared. What do you think of this?

Sorry for my delayed response. I have been down with flu for the past week –

Yes, there is definite “dynamic” shortening of the cervix. Shortening over a period of time is common; however, the rate at which your cervix is shortening needs definite monitoring.

Your doctors are partially right; there are no studies to date, that show that a particular type of treatment is “the best line of action” for cervical shortening. This applies for cerclage, progesterone shots, as well as bed rest. However, we have seen that moms who are on reduced activity/ bed rest are able to prolong their pregnancies much more than those who are not. There is some evidence in this regard.

Given your previous history, and your current rate of shortening, it would be better to be on reduced activity – no lifting, prolonged sitting, or standing. Bathroom privileges would be okay. It may also be worthwhile looking into the cerclage option before your cervix shortens too much, and before the weight of the growing uterus starts irritating an already shortened cervix. I am just curious, why more vigilant monitoring was not done earlier in your pregnancy, and why you were not offered a preventative cerclage in your 11th-13th week, especially with your previous history?

I am 21 weeks pregnant with twins. At my 16 week appointment I had cervical length of 5.35cm, which I thought was great, but at my 20 week appointment my cervical length was down to 3.57cm. I realize that that is still a good number, what I would like to know is if I am at risk for continued drastic reduction by my next appointment at 24 weeks. Nobody at my doctor’s office seems to be concerned, my question is should I be more aggressive about being seen before the 24 week mark? They say that after 24 weeks they will be seeing me every 2 weeks instead of every 4. Thank you for your help.

Hi! Not sure if you remember me, but I wrote you back when I was 18 and 22 weeks along with a short cervix. My cervix got down to 1.9 cm at 22 weeks and I was on bedrest until week 36 on weekly 17P alphahydroxy progesterone shots. I am happy to report that after 2 weeks OFF bedrest after 36 weeks, I made it to my csection date and my baby girl, Caralyn Elise was born full term, and a perfect 7 lbs ON august 18th! I think positive thinking, bedrest, and the shots worked!! I had NO cerclage and a ton of uterine irritability and my short cervix held on! I hope my story can inspire hope in those who need it!
Annie

Thank you for coming back and sharing your story – I am sure that a lot of the moms here will indeed get inspired and re energized. In fact, I just finished answering another mom re: the efficacy of bed rest – I hope she reads your story here.

May I ask you one general question that has confused me a while. At 28 weeks, my cervix length was 1.5cm, and at 31 weeks, it was effaced 80%. Are the cervix length and effacement the same metric of the cervix or are they two related things or are they completely irrelavant?

Length of the cervix and effacement are related – Effacement is thinning of the cervix. Effacement is measured from 0% effacement (which means that the cervix is not ready to open yet) to 100% effacement (which means that the cervix fully ready to open up). So, 80% thinning means, that there is no length of cervix left, and very little is left, before dilation (or opening up can start). Along with this, you can have 1-2 cms dilation as well. The length of the cervix has to get to 0 before any effacement can start.

Shortening, moving form posterior (backward facing) to anterior (forward facing), effacement and then dilation, are all ways in which maternal hormones slowly help the opening out of the cervix, just before and during labor and delivery. It is just that, when these processes start happening too early, it can lead to preterm labor.

Hi Dr,
Thank you for replying to my questions and I hope you are feeling better. I wanted to let you know that the progesterone suppositories did not have much effect on me and my cervix continued to shorten. As of Monday Sept 14, it measured at about 1cm. So they decided that the cerclage was now my best course of action, without it I would have surely delivered within the next week or so….the same time I delivered with my last pregnancy. Anyhow I had the procedure done and am currently taking it easy and trying to heal a bit. They measured me the day after the surgery and said the stitched were in a good place and my cervix was now measuring at about 1.7 cm. I go back in this Monday for a follow up appt. I am feeling very grateful that my cervical insufficiency was caught in time to do something about it. The dr’s again said no need for bed rest, they just told me to be on pelvic rest (no intercourse) and not to lift anything over 10lbs, and basically just to take it easy. They told me I have a 50/50 chance of carrying to term now, but they are more so concerned with just getting me past the 28 week mark, and every week there after is a blessing. I am hoping for the best. Is it normal to be still feeling some pinching sensations in and around my cervix?

Good to know that the cerclage was done in time, and that you are generally doing better.

Feeling pressure, pulling/stretching sensations in the pubic area internally are common in pregnancy, especially in the last trimester. With cerclage, and your shorter cervical length this would be expected, and nothing to be worried about.

Any sharp, shooting pain on the other hand, should be immediately checked by your care provider.

*update* 9/9/9 I was admitted into the hospital once I had failed an NST, My perinatal specialist requested a Contractional NST to be conducted. They had induced me with Putosin to determine how the baby would handle active labor. I was 34.5 weeks pregnant and was continuing to have contractions (small and irregular) and was still on Procardia. My cervix was holding up after 9 weeks of bedrest without any change (1.67). The doctor ruled the cervical shortning was a direct result of going into labor after having my gall bladder removed.
Again, I failed the Contractional NST and was rushed to delivery for my son. It was found his cord was wrapped arround his neck and torso and when I would have contractions, it was cutting off his circulation. Justin Martin weighed 4.8 lbs and was 17 3/4 inches long, he spent 9 days in the NICU. He had no issues breathing, he had to have a tube feed for 2 days but he moved along and showed no signs of any issues. We had no time to develop his lungs / pancreas / liver but he showed he was ready on his own.
Thank you Dr for your advise when I first discovered the outcome for my pregnancy. While my cervix wasn’t the doomsday for ending my pregnancy your advise meant a lot to me. Because I kept going back for those tests and took my care seriously, I was able to buy 9 weeks and deliver a healthy baby boy even if he was early.

Hope little Justin Martin is doing better and gaining weight and strength steadily. Hats off to you for taking such good care of yourself, and prolonging your pregnancy (despite all the curves you had to encounter) so that your baby was able to become more mature and could gain weight as well.

Thank you for coming back and updating us on this forum. Many of the other moms, I am sure will take heart from your experiences..

To continue my story…at 23 weeks my cervix length went down to 1.9 cm and I was put on bedrest for the rest of my pregnancy. My cervix length ranged from 1.7-2.1 cm with the cervical cerclage in place for the remainder of my pregnancy. I had my twins at 36 weeks because one of the babies was to low and was no longer growing well. I am now the proud mother of twin girls. The cervical cerclage along with bedrest helped me become a mother.

I went back to your posts to re-read them, and I am amazed at what brave moms like you can achieve. Yes, it takes patience, more patience and some good medical help – but, in the end, it is all worth it.

I am 36 years old and am currently 19 weeks pregnant. I have been on strict bed rest for a week due to a short cervix (2.2 cm) with funneling. I have had one round of 17p, which I will continue to receive weekly. I don’t think I’ve had any regular contractions. I go back to the perinatologist next Monday for another ultrasound.

1). Do you know why this is happening to me? Let me explain more about my history…..

Other than an elective D&C (early on) I had 16 years ago, I have not had any procedures on my cervix. I have a 22mo. baby and had a normal pregnancy and term, vaginal delivery. She was sort of a big baby (over 8 lbs and I’m petite) and her head was in the 93%, which caused me to have an episiotomy and she was delivered by suction cup. I was in labor for 12 hours and then pushed for another 2 hours. These are the only things I can think of in relation to my cervix. Additionally, I had a great deal of hip pain during and a few months after my pregnancy.

Just prior to this pregnancy, my FSH was 67 one month and it went down the next month and I got pregnant naturally. This pregnancy, I was on progesterone and estrogen (pills & patch), which I d/c at 12 weeks. I have had a fair amount of pain in my abdomen that went away with bed rest. I have also had intermittent twinges of sharp pain in what I feel like is my cervix.

2). Would you recommend a cerclage at this point?
3). What type of bed rest/restrictions would you recommend for me?

Thank you so much. This site has given insight into something that is very confusing to me.

Nothing that you mention in your past history really stands out as a predisposing factor to cervical shortening.

At 19 weeks, some of the OBs in our practice go ahead and put in the cerclage, just to be on the safer side. Others will not take the risk of irritating the uterus, and will choose to monitor to see if there is further shortening, and then manage it with bed rest alone. Either ways, there is not much research indicating which would be the best option.

I would recommend that you see how your perinatologist feels after your next check up. If the shortening is minimal, (sometimes after strict bed rest we have even seen improvements in length – which really have no explanation), then waiting and monitoring carefully every other week should be sufficient. This along with modified bed rest, no lifting, and no intercourse should be sufficient. In case there is further remarkable shortening or funneling, then cerclage could be considered – however, this would depend on whether your uterus is irritable at that point. In case of irritability, cerclage would not be recommended.

The milestones have nothing to do with the short cervix; they have everything to do with baby’s growth and development. So, for example by 28 weeks if the baby is born, they have good chances of survival – esp with good NICU support. Each week that further goes by, not only adds to baby’s weight and development of reflexes, but also adds to better organ maturity, especially the lungs – which is needed for life outside the womb. Anything past 34 weeks, the baby may need only basic monitoring in the NICU – if that – different babies mature differently. And, by 37 weeks the baby is full term and is ready for life outside the womb.

The reason milestones were mentioned in some of the posts – to encourage moms to look at their pregnancy one week at a time, and try to pull along as long as possible given their circumstances of shortening, funneling and uterine irritability.

I so hope you can help us, or even offer any straws to clutch at! My brothers partner is 18 wks pregnant with twins, hospitalised 2 days ago after some bleeding and now found to have membrane protruding from her cervix and some leakage of fluid. Dr has said they can’t push it back or put a stitch in for fear of rupturing it and has told them to just wait for the babies to die! After a scan tonight both babies are showing fine strong heartbeats and i just can’t believe they’re being left die.. Obviously mum and dad are devasted and in complete shock. The only prior relevant history i know about is that she did lose one baby from another twin pregnancy a few years ago, the other baby was fine.
I’ve spent the last 4 hrs reading all the posts here and thank you for this service from the bottom of my heart, you’ve shown so many people that there’s light at the end of a lot of tunnels!
Thank you for taking the time to read this.
Dympna

I am so sorry to hear about your brother’s partner’s condition in her pregnancy. However, with membrane protrusion, there is very little one can do. Some perinatologists will put the mom in reverse Trendelenburg position ( legs up, head down) in an effort to take the pressure off the cervix. The results are variable and not really validated by research.

Most babies born before the 24th week, have a very slim chance of survival. So, is not so much as the babies are being left to die. It is just that once the membranes rupture and delivery happens, either spontaneously or otherwise, the chances of survival esp. without disability, are minimal.

I just have one question – how did the mom lose one of her babies in ht previous pregnancy?

Good afternoon, Dr. Vijaya! I wrote you a few months ago about my friend who was on bedrest at 21 weeks. I am cautiously pleased to tell you that she delivered a healthy 4 lb, 1 oz baby girl yesterday, at 31w3d gestation! She’s breathing well, albeit with supplemental oxygen, and is doing very, very well for her gestational age. Thank you so much for your help and advice!

Please convey my congrats to your friend. Hope her baby is doing better and better each day

On a different note – we can almost always tell from the strength of the baby’s first cry if it is a boy or a girl, during delivery. The ones with the strong cries are almost always girls!! :) No wonder the that her little girl is doing so well for her gestational age!

i am 27 weeks and have been placed on strict bedrest both in the hospital and now a home.. My cervix is 1 inch and I am on Procardium evry 6 hrs. and progesterone suppositories. What are my chances of making it to 32 weeks or longer? Is there anything else that I can do to increase my chances?

1 inch (2.5 cms) is not so bad – yes, it requires frequent monitoring, and some modified bed rest, and not much else. Why are you on Procardia? Are you or were you experiencing frequent contractions? Progesterone suppositories at 27 weeks, fall in to the category of neither doing harm or good. So take it if your OB insists. You could also ask for a change to oral progesterone, which has less chances of irritating the cervix and the uterus.

Good news is, you are already at 27 weeks. By 28 weeks, the baby’s survival chances increase and they can give you shots to mature the baby’s lungs. Just take your bed rest seriously, and you should hopefully make to 34 weeks and even beyond !

I took progesterone and magnesium and was on strick bedrest from 23-36 weeks. I had c-section at 36 weeks because one of my twins was not growing at the rate we wanted. All three of us are doing great. Good luck to you.

Today I had my doctors appointment in the 24 week of my pregnancy. I was told I had a shortening cervix (2.6 cm). My concern is that this length was based on my ultra sound taken from the 19th week of my pregnancy. I have scheduled another Ultrasound in two days but I am wondering what the new length could be since it has been 5 weeks and I have exercised quite a bit since the 19 week U/S. Any thoughts on this? Could it stay the same? Could it shorten a little more OR a lot more? We were also told that the baby had a slightly enlarged right kidney. Is this dangerous? Common? Any thoughts you have on all of this would be greatly appreciated.

Yes, it is short – but not critical. You just need to be monitored closely for further shortening. Why are you having another ultrasound in 2 days – not much difference will be seen. Only difference will depend on the skills of the US tech, and if your bladder was empty or full the first time around.

Cervical lengths and how they shorten – vary form mom to mom. For some it happens gradually all thro’ the second and third trimesters. For some, their cervical lengths do not show much variation, and tend to shorten up at the end, rather speedily. So, in your case we will just have to wait and watch.

Baby’s enlarged right kidney should be monitored – please consult a pediatirc neonatologist to check further re: this.

Thanks for your response. Sorry to confuse you but the 19 weeks ultra sound was 5 weeks ago. I just saw my doctor yesterday and that is why I am going for another US tomorrow since I was 2.6 cm 5 weeks ago. I am trying to see what kind of results I can expect tomorrow since I was 2.6 cm five weeks ago.

I am currently 19 weeks with IVF twins, last Thursday I had a transvaginal ultrasound and the Dr picked up that I have only 1.1cm of cervix left, he said there was no funneling and my cerclage was holding with 1cm of cervix below it.
I had the cerclage placed at 13.5 weeks.
The doctor wanted to admit me for hospital bedrest but I asked if I could do it at home, he agreed to allow me to do this for a week and re scan me. If it shows that my cervix has shortened further I will be hospilised.
I lost my son 6 years ago to an incompetent cervix at 18 weeks with protruding membranes. I spent 3 years with post traumatic stress syndrome and couldn’t cope with my loss. I am petrified that it will happen again. I am currently on strict bedrest with just toilet allowances.

Sorry for this delay. I will reply in 1-2 days as we are quite tied up with births happening at our birthing center. Meanwhile, an important announcement –

Our website has undergone a revamp and as a result our Blog address has also changed. Please go to our new Blog address by going to http://www.healthy-mother.com and choose Blog menu on top to read all the answers to your questions. I will NOT be writing on this address any more.

you are an angel to answer all of this questions patiently. I have been very stressed during the last two weeks. I am 21 weeks pregnant and had an ultrasound at 16 w, my cervix measured 38mm but at 20 w the cervix shortened to 36mm.
My Dr has frightened me and told me that I might need surgery. Now I am wondering what to do and what to think? does it mean that I have an incompetent cervix? I was planning to travel to dubai next week? Am I considered as a high risk that should avoid travelling and bed rest?

Hello,
My sister is about 23 weeks and has a shortened cervix. Her doctor has asked her to stop working, but hasn’t ordered bed rest yet. Her doctor is going to refer her to a specialist. She has had 2 miscarriages at about 8 weeks, her third pregnancy, she delivered by c-section, her son is now 3yrs.old. So this is her 4th pregnancy. My sister also has gestational diabetes and has rashes which she had in her third pregnancy. Do these two conditions complicate things more?

I have had 3 previous d&c’s. Two were for missed miscarriages and 1 was for abortion. All were done between 6-7 weeks pregnant. i am currently pregnant. Should i be worried about cervical incompetence during this pregnancy because of the procedures?

I am writing to you about similar cervical issues that I am reading about on this message board.

In my first pregnancy, my cervix started shortening around 22-23 weeks. The Dr. did not put me on bedrest, but advised no exercise, intercourse or anything strenuous. My cervix looked much better a month later and I was told I could resume doing normal activities. At 33 weeks, I dilated 1cm and was put on strict bedrest. I carried to term and even had to be induced.

Due to early dilation in my previous pregancy, I have been seeing a peri since the beginning of my current pregnancy. My cervix was doing great until shortening was noticed at 23w. The peri called my measurements “dynamic” because it measured at 3.4cm, 2.6cm, 2.4cm and 1.9cm all during one TVU. It was recommended that I get a cerclage placed right away as there was concern about preterm delivery. After my husband and I did EXTENSIVE research, we decided against the procedure. There seemed to be risks involved and I felt that being almost 24w (when the procedure would’ve been done) with my measurements didn’t make me the best candidate for this procedure. I am now almost 25 weeks and my measurements at 24w 3d were in the 2.2 to 2.6 range.

My questions are as follows:

1. Do you think I made the right choice regarding the cerclage? I am now wondering if I made the right decision.

2. I am on modified bedrest, but have to care for my 18 mo. old. My OB said it was okay if I had to lift her a couple times a day and said it was okay to eat out at a restaurant as long as I am not overexerting myself. Do you agree with this advice?

3. What is the best position for me to be in to help my situation? For instance, some doctors say to be on your left side and others say to be on your back with feet elevated? Any advice?

4. Should I be really worried or just put on alert? I realize my measurements are not where they should be, but is modified bedrest okay at this stage or do I need to be more strict?

I’m 28 weeks pregnant with twins(fraternal) and this is my first pregnancy as a result of an IVF. I’m 32 years old, healthy, and my pregnancy has been perfect until now. When I was 24 weeks my cervical length was 2.8, a couple of weeks later it shortened to 2.5, then to 2.3 and in another week to 1.8. I did my fetal fibronectin test today and It was negative; I’m not having contractions or any other symptoms of preterm labor and I’ve been told that my cervix is thick, closed, and no funneling. Can I still have good chances of delivering at least at 35 weeks? I’m worried about my cervix shortening too much every week ? I’m in bed rest right now and walking a little bit at home; they’re monitoring me every week and my next fibronectin test is going to be next week. Thank you for any advice or opinion.

Hi Dr. Vijaya. My last pregnancy I had a cervical length of 1.3 with funneling at 20 weeks and given a cerclage and complete bed rest and went on to go full term. Now 19 weeks into 2nd (so far successful) pregnancy and my cervix is 3.2 with no funnel and being monitered about every 2 weeks. So far no cerclage, do you think I’ll need one? My doctor said he thinks maybe 50% chance but I thought once you need a cerclage you always need one. I’ve had 2 previous miscarriages, one at 6 weeks, one at 9 weeks. Any information you can give me would be appreciated! Thank you. Angela

This site is great I hope you can give me your insight on my current pregnancy and treatment.

My first pregnancy resulted in my son born at 36 weeks 4 days and he was 6lbs 10 oz. He is a perfect 3 year old. My labor started with my water breaking and contractions started right of. Labor lasted about 13 hours, including 3 hours of pushing and my son came out with his arm next to his head. Perfect natural labor and delivery with a midwife.

Second pregnancy was complicated form the start. Lots of bleeding, placenta previa and other non cervical related things like a false positive on a nuchal scan and an amnio but the baby was fine. Bleeding stopped around 14 weeks and the placenta moved up and I thought I was out of the woods. At 19 week routine scan I found out I was 4 cm dilated with my bad protruding into my vagina. I felt nothing leading up to this, no pressure, no pain, no contractions. No infection was found and I delivered my son a week later. I delivered vaginally and the placenta seemed to come out, but I hemorrhaged almost 4 weeks later and had a D&C. Resulted in Asherman’s Syndrome and needed hysteroscopy and hormone treatment, was told we may not be able to have nay more children. I seemed to have healed well and was finally given the green light to try again.

Now am almost 24 weeks pregnant with third pregnancy. This pregnancy has been a little complicated with fifths disease early on, a hematoma and 3 episodes of light bleeding. My periontologists were not convinced I had IC since I went to almost term with my first pregnancy and has so many complications in the second which may have caused the loss. They are also fairly anti-cerclage and say the research indicated they don’t improve outcomes but they were huge proponents of P17 shots. They didn’t want to do a preventative cerclage and preferred trans vaginal ultra sounds every week from 16 weeks on. Cervix started at 3cm then went to 2.7, 2.5 and eventually to 1.5 to 2.0ish at 19 weeks. I have felt no contractions at all, but some contractions were showing up on the ultra sounds as early as 13 weeks which tech’s and doctors all said was normal. There was some discrepancy in the last measurement and the doctor thought it was a little longer. They did a cerclage that day at exactly 19 weeks gestation.

I felt crampy and has some light spotting and was placed on bed rest can get up for bathroom (which seems like every hour) and light food. I had a follow up 5 days after cerclage where they did a manual exam of cervix and all seemed well cervix was closed and no pressure on the cerclage. I am skeptical of the manual exams so asked for a trans vaginal ultra sound but they guaranteed me a gentle manual exam would not cause me to go into labor.

I live over 2 hours from hospital so they said not to come back for 3 weeks. At the second appointment they did the same thing, manual exam. I asked for a fFN test and they said that with a cerclage there is not “clinical reason” for doing a fFN test. That was about a week ago and I continue to feel good, no pressure and no contractions and almost 24 weeks. I continue to get the P17 shots weekly but no other prescription drugs just prenatal and fish oil.

Questions for you:
1) Are gentle internal exams OK? I have felt some light cramping each time but had no spotting or contractions. If not how would you recommend I be monitored?
2) Is being monitored every 3 weeks OK for now? They said after my next appointment they would have me come every 2 weeks (after 27 weeks).
3) Should I have steroid injections incase I go into labor early?
4) Should I be concerned about the contractions shown on the ultra sounds even though I am not feeling anything?

I have a question – I have had 2 instances of preterm birth with my previous pregnancies. One at 24 weeks, and 1 at 23 weeks both times I was dilated and never really felt anything but when went to hospital I was having contractions and both times membranes ending up rupturing. I am now early in another pregnancy. I’ve been to two different doctors – one seems to think I need cerclage other seems to think I need 17P injections starting at around week 16. Since it has never been determined which actually came first in my previous pregnancies the dilation or the contractions, I feel that maybe both is the way to go. What advice can you offer me on this?

Dear dr . I am diana fonseca i have history of miscarages my firt one was at 7 weeks
other one at 4 weeks and last one at 21 weeks I used peogesterone suppositories for almost 6 weeks everything was going ok other then some
spoting in many occations at 20 weeks i started feeling presure in my lower pelvis when to the er maternity and found out that my cervix was
completely dilated so the put me on restric bed rest at the hospital the give me medications to prevent contraction and infections but after almost 2 weeks my babies hearth beet stops when i gotted in the hospital the water bag was bulging i pray i an i was so positive and faithful
that everything was going to be fine but it wasnt is very dificult to be going to the birth of your angel after all the hoping butsome some reazon happens and now he is with god and my other angels…….. Ok so now i am 16 weeks and and 2 days the did a cerclage at 13 weeks everything is been so geeat until yesterday that i whet to the dr because i stated feeling a
little of presure they did a vaginal ultrasound ad dr told me my cervix is 2.6 i am really worry they told me stay in bed and to take it easy and using progesterone shots everywek my question is how much hope i such have i think is to eatly to start having my cervix shotering please
help me i need all the infomation that i can have it will be very helpful

I am 21 weeks pregnant and have a vacation booked next month. I’m concerned about flying because I had a Leep done in 2005. I have an appt this week to check the length of my cervics but I was just curious to know your opinion.

Dear Doc. I had an emergant cerclage placed at 20 weeks because my cervix was open inside and out to 3cm and bulging membrains. I have been on bedrest since then. I will be 28 weeks on April 17th. Do you think my doc will let me have a little freedom? I left the hospital with 8mm of cervix. Went in one week later it was 21mm 15mm with preasure and the funneling was huge. I went in almost 3weeks ago and it measured at 23mm 15mm with preasure. I was just wondering if there is any hope of me getting to go places again with limited activity still!! I am going nuts and my brothers wedding is on my 28th week day!! Thanks I need some hope!!

I am curious about this, my doctor sent me for u/s to determine cervical length. I was 25 weeks and it was b/w 3 and 3.5. I had been at high risk with my second child for incompetent cervix and had had a leep done previous to my second pregnancy. I did not have a cerclage put in with my second pregnancy. I also had a second stage abortion prior to my second pregnancy as well. I have been having a lot of contractions this time around and I am currently 28 weeks. What are the chances I will carry to full term or that my cervix will not shorten and dilate on its own. Thanks

hi, Dr i’m 29 weeks and 3 day pregnant and i felt a lot of pressure with pain, i went to emergency room because i didn’t know what was going on.. since i had a misscariage before so when they measure my cervix is at 2.6cm. am i at great risk for premature delivery or misscarry again? they also see the head of the baby is al the way down is it safe or not!!! please reply i’m scared!!

At 18wk5 days I had leaked out quite a bit of amniotic fluid. I went to the hospital and they did an ultrasound. In the ultrasound (both pelvic and trans labia) they found my cervix to measure at 2.2cm. I was told to go off work and put on bed rest. Then I went back at 21wk6 days for a follow up. This technician said that my cervix looked fine. I know the cervix just can’t correct itself so what are the chances the first one was wrong? Don’t the radiologists do the final analysis and if the first scan was wrong would they have caught it? Should I just wait to see the final radiologist report says?

I am 19 weeks and 6 days I have had 3 miscarriages, 2 DC&E procedures and 2 beautiful little girls. I was spotting last night and went to the doctor today. He did an exam and said that my cervix is shortening. So I have an ultrasound tomorrow, and another dr appt friday. I know that a baby can not be saved this soon..so I am starting to worry. What are the odds of having a full term pregnancy with cervical shortening this early on.

Hi Dr. Vijaya,
I have really enjoyed reading your posts above. I am currently 32 weeks and have already been put on strict bedrest for the remainder of my pregnancy. At 31 weeks – I started to bleed and it was determined this was the show. When they did the transvaginal u/s – I was at 1.2 cm. The follow up u/s 4 days later showed a cervical length of 1.0 cm. I don’t think many of the docs expect me to carry to term (this is my first pregnancy and no history of miscarriages) but I am just wandering if you have any stats on the likelyhood of carrying to term based on what I have told you above. I am now going for weekly u/s to check the cervical length and if it goes below 0.5 cm – I am told I will be re-admitted to the hospital and will get to carry out my bedrest there.

I am 22 weeks pregnant and my cervix is currently 2.3 cm, I am being internally scanned every 2 weeks as my previous 2 pregnancys where delivered early, my 1st was at 34 weeks and my 2nd at 28 weeks, they began measuring my cervix at 14 weeks and it measured 3.1 then this went to 3.3, then 2.6, then last week it had gone down to 2.3, the hospital didn’t say that I needs bed rest nor restricted activity, only that I was to attend again in another 2 weeks, only when reading this web page I went to my doctor and she has now advised moderated activity and signed me off work, I am extremley worried for my unborn child and wanted to know your thoughts of this, I’m not sure why I had 2 prev pre term deliveres as they were not monitered although now I suspect this is the reason why.
As one was earlier than the other does this mean that my 3rd pregnancy will be delivered earlier than my 2nd pregnancy, i.e before 28 weeks? I have no funneling and no bleeding, is it better for me to sit down or lay down? And with my cervix decreasing do you think that it is likely that I will make it to 28 weeks? I’m worried to go outside and walk around or stand up for to long, is there anything that the doctors can give me to help my cervix from decreasing any further, I do not have a stitch at the moment, how late in pregnancy can this be inserted? And would u recommend one? also my babys head is really low down in my cervix and has been like that for the prev 2 scans I have had, does this have any bearing on my situation? Sorry for the 101 questions but I worried and really need to know what’s going on as the hospital isn’t really keeping me well informed with what’s going on on I want as much info on this as possible!!

dear dr,
my last pregnancy was complicating and i delivered in 26wks.
i was diagnosed with cervical incompetancy in 20 wks and i was leaking too. i had cerclarge and was put in complete bed rest. i started to leak again in 26wks.
i am planning for my next pregancy now. i am 45 now. this is gonna b my 3rd try. kindly advise what precautions i shd take or shd i even try cos i am already 45.

Found your article and posts of great information. Me and my wife are both engineers hence don’t understand much of these things… :(
Anyway my wife is 22 weeks pregnant and was diagnosed with 2.27 cm of cervix…doctor suggested my wife to rest for a week and then re-examine depending on which she will suggest for cerclage…could you suggest some ways of avoiding the same…

My teenage daughter is 21 weeks pregnant and has been having cramping and discomfort. Today they did an ultrasound to double check baby and mom. She had a ultrasound last Monday as well. From last monday to today her cervix has shortened and we are now scheduled to have another ultrasound friday. I am concerned. The baby seemed to be engaged today is this increasing her risk for preterm labor? What would you suggest be done in her case? I am unaware of the exact length from monday however todays exam showed 2.8 regular ultrasound and then vaginal 3.3…

Dear doctor,
I had a cerclage last may 5, the day after i had a bleeding but the doctor told me that everything is fine.. since then the bleed stops but last week i am suffering of itchiness on my vagina it might be because of the fluid coming out but since yesterday i felt heavy on my lower abdomen, i felt a lot of pain when im walking on the side and on my upper thigh, i feel pain inside like i have a UTI specialy after i pea it stings. Is it normal or should i consult my OB immediately coz my next appointment is on the first week of June

I am 21 weeks pregnant and had a ultra souind which said the my cervix length is about 3.2 cms and reduced to 2.7 cms when pressed with funnel. My care provider want to observe for couple of days and then to decide whether to stich or not. They have told me to be under bed rest. Doctor told that even if they stich i will have to be with less physical activity.

The problem is we are planning to have baby back in India, and as iam in US its very long journey. So if had a cerclage, will i be able to travel back to India safely with my baby? Or should i travel back to India and get cerclage done there if necessary? Is it safe anyways to travelback to India with a sharter Cervix? Kindly advise.

I had a cone biopsy done 2 years ago. My sister had her 1st daughter prematurely d/t shortened cervix. She then had cerclages for her next 2 pregnancies & carried to term. I am 15 weeks pregnant & I’m having a cervical ultrasound tomorrow morning. With the discussions I’ve had with my MD, I have a feeling he’s going to put the decision of a cerclage in my hands. I’m not sure what to decide.
Thank you,
Nicole

Hi,
Last Monday I went to my doctor to talk about the ultrasound I did when I was 12 weeks pregnant. 15 weeks today.
It said that my cervix was 2,7 cm long. And she warned me that I might have a premature baby. But she wasnt worried.
But my eldest was born 5 days after her due date. And after her birth a vien broke on the right side of my cervix and I had a stitch, and a year after I did a LEEP.
And on top of all this , I have to make a long air trip, I have to travel approximally 12 hours distance around my 22 weeks.
So my question is, why didnt she recommend cerclage? And when I told her that I have to travel on week 22, she said yeah why not.
So my second question is, if the lenght of my cervix gets shorter , can I travel? Or to be correct, would the trip cause me a misscarage?!

I am very very afraid, and worried! Trying to take it as easy as possible, and lifting any weight, and just waiting for the ultrasound on week 19.

Hello,
I am 26 weeks pregnant today. I have a history of pre-term labor and complications during pregnancy. I had my first cervical length u/s a week ago. last week my cervix was 2.68cm. I ended up going into this OB traige this past Sunday for contractions, pressure and cramping. They ran all tests everything came out normal EXCEPT the fFN test which was positive. They kept me here at the hospital to issue medication for the baby’s lungs and to stop the contractions. Today I had another u/s and showed that my cervix shortened, it is now 2.37cm at rest and 2.23 barring down. First, I would like to ask you what are thoughts of how accurate the fFN test is both with a positive and neg result and your thoughts behind the change of my cervix within a 1 week time period and gestation.
Thank You,

I am currently 20 weeks pregnant and have had a roller coaster of a pregnancy. First I had a bad quad test and then I had a bad level two ultrsound (showing signs of DS or cystic fibrosis). I had and amnio done and the results showed my baby was fine! YEAH! Then I went to the dr today to check my cervix length. (I had a LEEP procedure done so they wanted to moniter the length). The dr told me today that my cervix was 1.61 (he said nothing about funneling). He did check and I am not dialating at all. When I went in at 16 weeks I was 3.5 and now being 1.61 four weeks that later scares me. The doctor wants to see me again tomorrow (friday) and again on Monday. He said that if he shortens more by Monday he will continue to check me everyday. If not he will check me every 48 – 72 hours. Do you think there is something he is not telling me and that is why he wants to check me so often? He also told me about the stint, but said it does not prove effective (and he is a numbers man). He said it does however prove more effective if you have already started to dialate. He does not know why, but that is what the numbers show. He said he could write me a note about bed rest, but said that it would not make much difference. I am just really concerned. He didn’t even seem very optomistic about me making it to 28 weeks. Is this because it reduced so much in a short time? I can not have the one test done until I am 22 weeks to see if I am going into premature labor. Should i go on bed rest? What are my odds of making it 28 weeks?